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SLI 2007 No. 355 Regulations as made
These Regulations repeal the Health Insurance (General Medical Services Table) Regulations 2006 and make the Health Insurance (General Medical Services Table) Regulations 2007.
Administered by: Health
Made 17 Oct 2007
Registered 19 Oct 2007
Tabled HR 12 Feb 2008
Tabled Senate 12 Feb 2008
Date of repeal 01 Nov 2008
Repealed by Health Insurance (General Medical Services Table) Regulations 2008
This Legislative Instrument has been subject to a Motion to Disallow:
Motion Date:
18-Jun-2008
Expiry Date:
17-Sep-2008
House:
Senate
Details:
Partial
Resolution:
Withdrawn
Resolution Date:
17-Sep-2008
Resolution Time:
Provisions:
item 16525, part 3 of sch 1

Health Insurance (General Medical Services Table) Regulations 20071

Select Legislative Instrument 2007 No. 355

I, PHILIP MICHAEL JEFFERY, Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 17 October 2007

P. M. JEFFERY

Governor‑General

By His Excellency’s Command

TONY ABBOTT


Contents

                        1     Name of Regulations                                                        7

                        2     Commencement                                                              7

                        3     Repeal                                                                            7

                        4     Definitions                                                                       7

                        5     General medical services table                                          7

Schedule 1             Table of general medical services                                8

Part 1                      Prescription of table                                                         8

                        1     Prescription of table                                                         8

Part 2                      Rules of interpretation                                                      8

                        2     Application of table                                                          8

                        3     General                                                                           8

                        4     Meaning of symbols (S) and (G)                                      15

                        5     Meaning of symbol (H)                                                    16

                        6     Meaning of a patient’s medical condition requires urgent treatment and responsible person in certain items                                                                            17

                        7     Application of items 2, 98, 448, 449, 602 and 698             18

                        8     Meaning of single course of treatment in certain circumstances          18

                        9     Meaning of professional attendance in certain items          19

                       10     Interpretation of items 104 to 147, 291 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 17640, 17645, 17650 and 17655                                                 20

                       11     Meaning of amount under rule 11 in certain items              20

                       12     Personal attendance by medical practitioners generally     22

                       13     Personal attendance by certain medical practitioners        23

                       14     Meaning of qualified medical acupuncturist in items 193, 195, 197 and 199      24

                       15     Restriction of telepsychiatry consultations to rural and remote areas    25

                       16     Consultant occupational physicians                                 25

                       17     Public health physicians                                                 25

                       18     Meaning of recognised emergency department and problem focussed history in Group A21       26

                       19     Prolonged attendances by emergency physicians             26

                       20     Application of items in Group A14 to certain patients only  27

                       21     Meaning of health assessment in items 700, 702, 704 and 706           28

                       22     Meaning of child health check in item 708                        29

                       23     Meaning of adult health check in item 710                        31

                       24     Meaning of comprehensive medical assessment in item 712 33

                       25     Meaning of health assessment in items 714 and 716         34

                       26     Meaning of humanitarian visa holder in items 714 and 716 34

                       27     Health checks of 45–49 year olds — item 717                  35

                       29     Limitation on items 721, 723, 725, 727, 729 and 731         38

                       30     Meaning of GP management plan                                    40

                       31     Meaning of multidisciplinary discharge care plan               40

                       32     Meaning of team care arrangements                                41

                       33     Meaning of associated medical practitioner                      42

                       34     Meaning of review of plans                                              42

                       35     Meaning of co‑ordinate a review of team care arrangements or of a multidisciplinary care plan    43

                       36     Meaning of contribute to a multidisciplinary care plan for items 729 and 731     44

                       37     Service by certain medical practitioners — items 729 to 866 45

                       38     Application of items in Group A15 to certain patients only  46

                       39     Meaning of multidisciplinary case conference                   47

                       40     Meaning of multidisciplinary discharge case conference    48

                       41     Meaning of multidisciplinary case conference in a residential aged care facility 48

                       42     Meaning of multidisciplinary case conference team           48

                       43     Meaning of organise and co‑ordinate in a multidisciplinary case conference and participation in a multidisciplinary case conference                                    49

                       44     Meaning of co‑ordinate in item 880                                  50

                       45     Meaning of case conference team in item 880                  51

                       46     Application of item 880                                                   52

                       47     Meaning of living in a community setting in item 900         52

                       48     Meaning of residential medication management review in item 903       52

                       49     Meaning of amount under rule 49 in certain items              54

                       50     Application of items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616                                                               55

                       51     Application of Subgroup 2 of Group A18 and Subgroup 2 of Group A19 55

                       52     Application of Subgroup 3 of Group A18 and Subgroup 3 of Group A19 56

                       53     Application of Group A24                                                57

                       54     Meaning of expressions used in rules 55 to 57 and Group A20            58

                       55     GP Mental Health Care Plans (Subgroup 1 of Group A20)  59

                       56     Application of items in Subgroup 1 of Group A20               61

                       57     Focussed psychological strategies                                  62

                       58     Application of Group A28                                                63

                       59     Item 4001                                                                      64

                       60     Meaning of outer metropolitan specialist trainee in items 5906, 5908, 5910 and 5912    64

                       61     Application of items 1 to 10943                                       65

                       62     Certain services may be provided by persons other than medical practitioners  65

                       63     Application of items 5000 to 5267                                    66

                       64     Items 10809 and 10929 not to apply in certain circumstances 66

                       65     Application of item 10988                                                66

                       66     Application of item 10989                                                67

                       67     Application of items 10990, 10991 and 10992                   67

                       68     Application of item 10993                                                70

                       69     Application of items 10994 and 10995                              70

                       70     Application of item 10996                                                71

                       72     Application of items 10998 and 10999                              72

                       73     Limitation on certain items                                              72

                       74     Application of items 10900, 10940 and 10941                   73

                       75     Application of items 10931, 10932 and 10933                   73

                       76     Limitation of items 10943, 16590, 18360, 18364 and 50303 74

                       77     Meaning of qualified sleep medicine practitioner                74

                       78     Meaning of report in Group D1 — Miscellaneous diagnostic procedures and investigations         76

                       79     Meaning of treatment cycle of a patient                            76

                       80     Items provided as part of treatment cycle relating to assisted reproductive services not to apply 76

                       81     Items relating to assisted reproductive services not to apply in certain pregnancy‑related circumstances                                                               77

                       82     Meaning of embryology laboratory services in items 13200 and 13206  77

                       83     Application of items 14227, 14230, 14233, 14236, 14239 and 14242    77

                       84     Injection of immunomodulating agent                               78

                       85     Meaning of amount under rule 86 in certain items              78

                       86     Meaning of approved site in items 15338 and 37220          79

                       87     Application of items 15556, 15559 and 15562                   79

                       88     Meaning of delivery in certain items                                 79

                       89     Meaning of amount under rule 89 in items 16633 and 16636 80

                       90     Meaning of amount under rule 90 in items 18219 and 18227 80

                       91     Injection of botulinum toxin                                              80

                       92     Meaning of expressions used in rule 93 and item 16400    81

                       93     Application of item 16400                                                82

                       94     Group T10 applies only in connection with certain services 82

                       95     Services specified in Subgroups 21 to 25 of Group T10      83

                       96     Meaning of service time in Subgroups 21, 24, 25 and 26 of Group T10 83

                       97     Application of Subgroup 21 of Group T10                          84

                       98     Application of Subgroups 22 and 23 of Group T10             84

                       99     Meaning of amount under rule 99 in items 25025, 25030 and 25050     84

                     100     Application of Subgroups 24 and 25 of Group T10             85

                     101     Meaning of complex paediatric case in item 25205            85

                     102     Meaning of amount under rule 102 in items 25200 and 25205  86

                     103     Group T8 services may be provided by a specialist trainee 86

                     104     Meaning of amount under rule 104 in item 30001               87

                     105     Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures                                                        87

                     106     Meaning of amount under rule 106 in item 31340               87

                     108     Meaning of qualified surgeon in items 31539 and 31545     87

                     109     Meaning of qualified radiologist in item 31542                   88

                     110     Meaning of foreign body in items 35360 to 35363              88

                     111     Application of items 35404, 35406 and 35408                   88

                     112     Application of items 30299 and 30300                              88

                     113     Application of items 30440, 30451, 30492 and 30495        88

                     114     Application of item 35412                                                89

                     115     Application of items 38365, 38368 and 38654                   89

                     116     Application of items 38470 to 38766                                89

                     117     Meaning of amount under rule 117 in certain items            89

                     118     Meaning of maxilla in certain items                                  90

                     119     Items 46300 to 46534 apply only in certain circumstances 90

                     120     Assistance at operations                                                90

                     121     Application of items 51700 to 53706                                90

                     122     Meaning of amount under rule 122 in items 51303 and 51803  91

                     123     Meaning of amount under rule 123 in item 51309               91

                     124     Meaning of amount under rule 124 in item 51312               91

                     125     Meaning of previous significant surgical complication in item 51318     91

                     126     Cleft lip and cleft palate services                                      92

                     127     Meaning of (AD) in Group C2 — Oral and maxillofacial surgical services and Group C3 — General and prosthodontic services                                              92

                     128     Orthodontic services                                                       92

                     129     Oral surgery services                                                      93

Part 3                      Services and fees                                                           94

Part 4                      Non‑medicare services                                                  575

 

 


 

  

  

1              Name of Regulations

                These Regulations are the Health Insurance (General Medical Services Table) Regulations 2007.

2              Commencement

                These Regulations commence on 1 November 2007.

3              Repeal

                The Health Insurance (General Medical Services Table) Regulations 2006 are repealed.

4              Definitions

                In these Regulations:

Act means the Health Insurance Act 1973.

this table means the table of general medical services set out in Schedule 1.

5              General medical services table

                The table of medical services (other than diagnostic imaging services and pathology services) set out in Schedule 1 is prescribed for subsection 4 (1) of the Act.


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; and

                (c)    in Part 4 — additional supporting information.

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:

2004 General Medical Services Table (or 2004 GMST) means the table prescribed for subsection 4 (1) of the Act by the Health Insurance (General Medical Services Table) Regulations 2004 as in force immediately before 1 November 2005.

ACRRM means the Australian College of Rural and Remote Medicine.

after‑hours period means any of the following:

                (a)    a public holiday;

               (b)    a Sunday;

                (c)    before 8 am, or after 1 pm, on a Saturday;

               (d)    before 8 am, or after 8 pm, on any day other than a Saturday, Sunday or public holiday.

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 means treatment of a dislocation or fracture by non‑operative reduction, including 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 in relation to whom a determination is in force under regulation 6DA of the Health Insurance Regulations 1975 recognising that he or she meets the fellowship standards of the ACRRM; or

               (d)    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

                (e)    an eligible non‑vocationally recognised medical practitioner; or

                (f)    a practitioner who is undertaking a placement in general practice as part of the Pre‑vocational General Practice Placements Program administered by the ACRRM, RACGP or GPET; or

                (g)    a practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited.

GPET means the body registered under the Corporations Act 2001 as General Practice Education and Training Limited (ACN 095 433 140).

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.

Note   Because of the Health Insurance (Allied Health and Dental Services) Determination 2007, certain health services are treated as if there were an item in this table, the diagnostic imaging services table or the pathology services table relating to that health service. A reference in this table to such an item is followed by an asterisk, with a note at the foot of the provision explaining what the asterisk means. (See rule 55 for an example.)

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)    for 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.

unsociable hours means between 11 pm and 7 am on any day.

         (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 registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and

                         (ii)    is providing general medical services in accordance with that Program; 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 Medicare Australia CEO has written notice; or

                (c)    a medical practitioner who:

                          (i)    is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners 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; or

               (d)    a medical practitioner who:

                          (i)    is registered as a medical practitioner under the After Hours Other Medical Practitioners 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.

         (4)   For subrule (3):

                (a)    the Rural Other Medical Practitioners’ Program is a program administered by the Medicare Australia CEO that, in relation to medical services provided in accordance with the Program, 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; and

                (c)    the MedicarePlus for Other Medical Practitioners Program is a program administered by the Medicare Australia CEO that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and

               (d)    the After Hours Other Medical Practitioners Program is a program administered by the Medicare Australia CEO 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 symbol (H)

                An item including the symbol (H) applies only to a service performed or provided in a hospital.

6              Meaning of a patient’s medical condition requires urgent treatment and responsible person in certain items

         (1)   For items 1, 2, 97, 98, 448, 449, 601, 602, 697 and 698, a patient’s medical condition requires urgent treatment if:

                (a)    medical opinion is to the effect that the patient’s medical condition requires treatment within the unbroken after‑hours period in, or before, which the attendance mentioned in the item was requested; and

               (b)    treatment could not be delayed until the start of the next in‑hours period.

         (2)   For subrule (1), medical opinion is to a particular effect if:

                (a)    the attending practitioner is of that opinion; and

               (b)    in the circumstances that existed and on the information available when the opinion was formed, that opinion would be acceptable to the general body of medical practitioners.

         (3)   For items 1, 2, 97, 98, 448, 449, 601, 602, 697 and 698:

responsible person, for a patient:

                (a)    includes a spouse, parent, carer or guardian of the patient; and

               (b)    does not include:

                          (i)    the attending medical practitioner; or

                         (ii)    an employee of the attending medical practitioner; or

                         (iii)    a person contracted by, or an employee or member of, the general practice of which the attending medical practitioner is a contractor, employee or member; or

                        (iv)    a call centre; or

                         (v)    a reception service.

7              Application of items 2, 98, 448, 449, 602 and 698

                Items 2, 98, 448, 449, 602 and 698 do not apply to a service provided by a medical practitioner:

                (a)    who routinely provides services to patients in after‑hours periods at consulting rooms; or

               (b)    who provides the service (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in after‑hours periods at consulting rooms.

8              Meaning of single course of treatment in certain circumstances

         (1)   In subrules 3 (1), 4 (1) and 8 (1) and items 104, 105, 106, 107, 108, 109, 110, 116, 119, 122, 128, 131, 133, 385, 386, 387, 388, 2801, 2806, 2814, 2824, 2832, 2840, 3005, 3010, 3014, 3018, 3023, 3028, 6007, 6009, 6011, 6013 and 6015, 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.

9              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, 700 to 799, 900 to 903, 2501 to 2727, 2801 to 2840, 3005 to 3028, 5000 to 5267, 6007 to 6015, 10900 to 10929 and 17610 to 17680, 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 and 5000 to 5267, 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.

10            Interpretation of items 104 to 147, 291 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 17640, 17645, 17650 and 17655

         (1)   In items 104 to 147, 291 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 17640, 17645, 17650 and 17655 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.

11            Meaning of amount under rule 11 in certain items

                In this table:

amount under rule 11, for an item mentioned in the following table, means the sum of:

                (a)    the fee mentioned in column 3 for the item; and

               (b)    either:

                          (i)    if not more than 6 patients are attended at a single attendance — the amount mentioned in column 4 for the item, divided by the number of patients attended; or

                         (ii)    if more than 6 patients are attended at a single attendance — the amount mentioned in column 5 for the item.

Item

Items of this table

Fee

Amount if not more than 6 patients (to be divided by the number of patients)

Amount if more than 6 patients

1

4, 13, 19

The fee for item 3

$22.95

$1.70

2

20

The fee for item 3

$41.35

$3.00

3

24, 25, 33

The fee for item 23

$22.95

$1.70

4

35

The fee for item 23

$41.35

$3.00

5

37, 38, 40

The fee for item 36

$22.95

$1.70

6

43

The fee for item 36

$41.35

$3.00

7

47, 48, 50

The fee for item 44

$22.95

$1.70

8

51

The fee for item 44

$41.35

$3.00

9

58, 81, 87

$8.50

$15.50

$0.70

10

59, 83, 89, 2610, 2631, 2673

$16.00

$17.50

$0.70

11

60, 84, 90, 2613, 2633, 2675, 2707

$35.50

$15.50

$0.70

12

65, 86, 91, 2616, 2635, 2677, 2708

$57.50

$15.50

$0.70

13

92

$8.50

$27.95

$1.25

14

93

$16.00

$31.55

$1.25

15

95

$35.50

$27.95

$1.25

16

96

$57.50

$27.95

$1.25

17

195

The fee for item 193

$22.95

$1.70

18

414

The fee for item 410

$22.95

$1.70

19

415

The fee for item 411

$22.95

$1.70

20

416

The fee for item 412

$22.95

$1.70

21

417

The fee for item 413

$22.95

$1.70

22

716

The fee for item 714

$22.95

$1.70

23

5003, 5007

The fee for item 5000

$22.95

$1.70

24

5010

The fee for item 5000

$41.35

$3.00

25

5023, 5026

The fee for item 5020

$22.95

$1.70

26

5028

The fee for item 5020

$41.35

$3.00

27

5043, 5046

The fee for item 5040

$22.95

$1.70

28

5049

The fee for item 5040

$41.35

$3.00

29

5063, 5064

The fee for item 5060

$22.95

$1.70

30

5067

The fee for item 5060

$41.35

$3.00

31

5220, 5240

$18.50

$15.50

$0.70

32

5223, 5243

$26.00

$17.50

$0.70

33

5227, 5247

$45.50

$15.50

$0.70

34

5228, 5248

$67.50

$15.50

$0.70

35

5260

$18.50

$27.95

$1.25

36

5263

$26.00

$31.55

$1.25

37

5265

$45.50

$27.95

$1.25

38

5267

$67.50

$27.95

$1.25

12            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 698, 2497 to 10816, 2713, 6007 to 6015, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11724, 11921, 12000, 12003, 12201, 13030, 13100, 13103, 13104, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13700, 13815, 13818, 13830, 13839, 13842, 13847, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13881, 13882, 13885, 13888, 14100, 14106, 14109, 14112, 14115, 14118, 14124, 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)   Items 700 to 727, 900, 903, 2710 and 2712 apply only to a service provided in the course of personal attendance by a single medical practitioner on a single patient.

         (5)   For this rule, each of the following is taken to be personal attendance by the medical practitioner on a patient:

                (a)    an attendance by a medical practitioner on a patient by way of a telepsychiatry consultation to which any of items 353 to 361 applies;

               (b)    an attendance by a medical practitioner on a patient in relation to the planning, management and supervision of the patient on home dialysis to which item 13104 applies.

13            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 727, 900 to 10816, 2710, 2712, 2713, 6007 to 6015, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11722, 11724, 11820, 11921, 12000, 12003, 12201, 13030, 13100, 13103, 13104, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13700, 13815, 13818, 13830, 13839, 13842, 13847, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13881, 13882, 13885, 13888, 14100, 14106, 14109, 14112, 14115, 14118, 14124, 14200, 14203, 14206, 14209, 14212, 14215, 14224, 15600, 16003 to 16512, 16515 to 16573 and 16600 to 51318.

         (4)   For this rule, each of the following is taken to be personal attendance by the medical practitioner on a patient:

                (a)    an attendance by a medical practitioner on a patient by way of a telepsychiatry consultation to which any of items 353 to 361 applies;

               (b)    an attendance by a medical practitioner on a patient in relation to the planning, management and supervision of the patient on home dialysis to which item 13104 applies.

14            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 Medicare Australia CEO 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.

15            Restriction of telepsychiatry consultations to rural and remote areas

                Each of items 353 to 361 applies only to a consultation that is provided to a patient located in an R1, R2, R3, Rem1 or Rem2 area within the meaning of the Rural, Remote and Metropolitan Areas Classification.

16            Consultant occupational physicians

                A fee specified for an attendance by a consultant occupational physician applies only if the attendance relates to 1 or more of the following matters:

                (a)    evaluation and assessment of a patient’s rehabilitation requirements when, 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 when causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.

17            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.

18            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.

19            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.

20            Application of items in Group A14 to certain patients only

         (1)   Items 700, 702, 704 and 706 apply only to a service for 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 a care recipient in a residential aged care facility.

         (2)   Item 710 applies only to a service for a patient who is:

                (a)    of Aboriginal or Torres Strait Islander descent; and

               (b)    at least 15 years old and less than 55 years old; and

                (c)    not an in‑patient of a hospital or a care recipient in a residential aged care facility.

         (3)   Item 714 applies only to a service for a patient who:

                (a)    has been a humanitarian visa holder for less than 12 months at the time of the service; or

               (b)    first entered Australia less than 12 months before the service.

         (4)   Item 716 applies only to a service in relation to a patient who:

                (a)    is a person who:

                          (i)    has been a humanitarian visa holder for less than 12 months at the time of the service; or

                         (ii)    first entered Australia less than 12 months before the service; and

               (b)    is not an in‑patient of a hospital or a care recipient in a residential aged care facility.

         (5)   Items 718 and 719 apply only to a service for a patient who:

                (a)    has an intellectual disability; and

               (b)    is not an in‑patient of a hospital or an approved day hospital facility, or a care recipient in a residential aged care facility.

         (6)   For items 704, 706, 708 and 710, a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.

         (7)   For items 718 and 719, a person has an intellectual disability if he or she:

                (a)    has general intellectual functioning at 2 standard deviations below the average intelligence quotient; and

               (b)    would benefit from assistance with daily living activities.

21            Meaning of health assessment in items 700, 702, 704 and 706

         (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 or 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.

22            Meaning of child health check in item 708

         (1)   For item 708, a child health check means the assessment of:

                (a)    a patient’s health and physical, psychological and social function; and

               (b)    whether preventative health care, education and other assistance should be offered to the patient, or the patient’s parent or carer, to improve the patient’s health and physical, psychological or social function.

         (2)   A child health check of a patient involves all of the following:

                (a)    a personal attendance by a medical practitioner;

               (b)    taking the patient’s medical history, including the following:

                          (i)    mother’s pregnancy history;

                         (ii)    birth and neo‑natal history;

                         (iii)    breastfeeding history;

                        (iv)    weaning, food access and dietary history;

                         (v)    physical activity;

                        (vi)    previous presentations, hospital admissions and medication usage;

                        (vii)    relevant family medical history;

                       (viii)    immunisation status;

                        (ix)    vision and hearing (including neonatal hearing screening);

                         (x)    development (including achievement of age appropriate milestones);

                        (xi)    family relationships, social circumstances and whether the person is cared for by another person;

                        (xii)    exposure to environmental factors (including tobacco smoke);

                       (xiii)    environmental and living conditions;

                       (xiv)    educational progress;

                       (xv)    stressful life events;

                       (xvi)    mood (including incidence of depression and risk of self‑harm);

                      (xvii)    substance use;

                     (xviii)    sexual and reproductive health;

                       (xix)    dental hygiene (including access to dental services);

                (c)    examination of the patient, including the following:

                          (i)    measurement of height and weight to calculate body mass index and position on the growth curve;

                         (ii)    newborn baby check (if not previously completed);

                         (iii)    vision (including red reflex in a newborn);

                        (iv)    ear examination (including otoscopy);

                         (v)    oral examination (including gums and dentition);

                        (vi)    trachoma check, if indicated;

                        (vii)    skin examination, if indicated;

                       (viii)    respiratory examination, if indicated;

                        (ix)    cardiac auscultation, if indicated;

                         (x)    development assessment, if indicated, to determine whether age appropriate milestones have been achieved;

                        (xi)    assessment of parent and child interaction, if indicated;

                        (xii)    other examinations:

                                   (A)     in accordance with national or regional guidelines or specific regional needs; or

                                   (B)     as indicated by a previous child health assessment;

               (d)    undertaking or arranging any required investigation, considering the need for the following tests, in particular:

                          (i)    haemoglobin testing for those at a high risk of anaemia;

                         (ii)    audiometry, if required, especially for those of school age;

                (e)    assessing the patient using the information gained in the child health check;

                (f)    making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

         (3)   A child health check also includes:

                (a)    keeping a record of the child health check; and

               (b)    offering the patient, or the patient’s parent or carer, a written report about the health check, with recommendations about matters covered by the health check (including a simple strategy for the good health of the patient).

23            Meaning of adult health check in item 710

         (1)   For item 710, an adult health check means the assessment of:

                (a)    a patient’s health and physical, psychological and social function; and

               (b)    whether preventative health care, education and other assistance should be offered to that patient, to improve the patient’s health and physical, psychological or social function.

         (2)   An adult health check of a patient involves all of the following:

                (a)    a personal attendance by a medical practitioner;

               (b)    taking the patient’s medical history, including the following:

                          (i)    current health problems and risk factors;

                         (ii)    relevant family medical history;

                         (iii)    medication usage (including medication obtained without prescription or from other doctors);

                        (iv)    immunisation status, by reference to the appropriate current age and sex immunisation schedule;

                         (v)    sexual and reproductive health;

                        (vi)    physical activity, nutrition and alcohol, tobacco or other substance use;

                        (vii)    hearing loss;

                       (viii)    mood (including incidence of depression and risk of self‑harm);

                        (ix)    family relationships and whether the patient is a carer, or is cared for by another person;

                (c)    examination of the patient, including the following:

                          (i)    measurement of the patient’s blood pressure, pulse rate and rhythm;

                         (ii)    measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity;

                         (iii)    oral examination (including gums and dentition);

                        (iv)    ear and hearing examination (including otoscopy and, if indicated, a whisper test);

                         (v)    urinalysis (by dipstick) for proteinurea;

               (d)    undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs):

                          (i)    fasting blood sugar and lipids (by laboratory based test on venous sample) or, if necessary, random blood glucose levels;

                         (ii)    pap smear;

                         (iii)    examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35 years);

                        (iv)    mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral);

                (e)    assessing the patient using the information gained in the adult health check;

                (f)    making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

         (3)   An adult health check also includes:

                (a)    keeping a record of the adult health check; and

               (b)    offering the patient a written report about the health check, with recommendations about matters covered by the health check (including a simple strategy for the good health of the patient).

24            Meaning of comprehensive medical assessment in item 712

         (1)   For item 712, a comprehensive medical assessment of a resident of a residential aged care facility is a full systems review of the resident, including an assessment of the resident’s health and physical and psychological function.

         (2)   A comprehensive medical assessment involves all of the following:

                (a)    a personal attendance by a medical practitioner;

               (b)    taking a detailed relevant medical history;

                (c)    conducting a comprehensive medical examination of the resident;

               (d)    developing a list of diagnoses and medical problems based on the medical history and examination;

                (e)    providing, for the resident’s records, a written summary of the outcomes of the assessment to inform the provision of care for the resident and to assist in the provision of medication management review services for the resident.

         (3)   A comprehensive medical assessment also includes:

                (a)    making a written summary of the comprehensive medical assessment; and

               (b)    providing a copy of the summary to the residential aged care facility; and

                (c)    offering the resident a copy of the summary or relevant parts of the summary.

25            Meaning of health assessment in items 714 and 716

         (1)   In items 714 and 716, 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 or social function.

         (2)   A health assessment involves all of the following:

                (a)    a personal attendance by a medical practitioner;

               (b)    taking the patient’s medical history;

                (c)    examination of the patient;

               (d)    undertaking or arranging any required investigations;

                (e)    assessing the patient using the information gained in paragraphs (b) to (d);

                (f)    developing a management plan addressing the patient’s health care needs, health problems and relevant conditions;

                (g)    making or arranging any necessary interventions and referrals.

         (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.

26            Meaning of humanitarian visa holder in items 714 and 716

                In items 714 and 716:

humanitarian visa holder means a person who is the holder of a visa of any of the following subclasses granted under the Migration Act 1958:

                (a)    Subclass 200 (Refugee) visa;

               (b)    Subclass 201 (In‑country Special Humanitarian) visa;

                (c)    Subclass 202 (Global Special Humanitarian) visa;

               (d)    Subclass 203 (Emergency Rescue) visa;

                (e)    Subclass 204 (Woman at Risk) visa;

                (f)    Subclass 447 (Secondary Movement Offshore Entry (Temporary)) visa;

                (g)    Subclass 451 (Secondary Movement Relocation (Temporary)) visa;

                (h)    Subclass 785 (Temporary Protection) visa;

                 (i)    Subclass 786 (Temporary (Humanitarian Concern)) visa;

                (j)    Subclass 866 (Protection) visa.

27            Health checks of 45–49 year olds — item 717

         (1)   For item 717, a patient is at risk of developing a chronic disease if, in the clinical judgement of the attending medical practitioner, based on the identification of a specific risk factor, the patient is at risk of developing a chronic disease.

         (2)   For subrule (1), specific risk factors include (but are not limited to):

                (a)    lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol misuse; and

               (b)    biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; and

                (c)    family history of a chronic disease.

         (3)   For subrule (1), a chronic disease is a disease that has been, or is likely to be, present for at least 6 months, including (but not limited to) asthma, cancer, cardiovascular illness, diabetes mellitus, a mental health condition, arthritis and a musculoskeletal condition.

         (4)   The health check should generally be undertaken by the patient’s usual doctor, that is, the medical practitioner who has provided the majority of services to the patient in the past 12 months, or is likely to provide the majority of services in the next 12 months.

         (5)   The health check must include the following components:

                (a)    information collection, including taking a patient history and undertaking examinations and investigations as required;

               (b)    making an overall assessment of the patient;

                (c)    interventions as indicated;

               (d)    providing advice and information to the patient.

         (6)   Item 717 is applicable only once for the same patient.

         (7)   The medical practitioner providing the service mentioned in item 717 is responsible for the overall health check of the patient.

         (8)   Elements of the health check may be delegated by the medical practitioner to a practice nurse or other qualified health professional.

         (9)   Item 717 is not applicable to a service provided to an admitted patient of a hospital.

       (10)   In this rule:

practice nurse means a registered nurse or an enrolled nurse who is employed by, or whose services are otherwise retained by, a medical practitioner.

28            Meaning of health assessment in items 718 and 719

         (1)   In items 718 and 719:

health assessment means the assessment of:

                (a)    a patient’s physical, psychological and social function; and

               (b)    whether any medical intervention and preventative health care is required.

         (2)   For subrule (1), a health assessment must include the following matters to the extent they are relevant to the patient:

                (a)    check dental health (including dentition);

               (b)    conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);

                (c)    assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);

               (d)    assess nutritional status (including weight and height measurements) and a review of growth and development;

                (e)    assess bowel and bladder function (particularly for incontinence or chronic constipation);

                (f)    assess medications including:

                          (i)    non‑prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications; and

                         (ii)    advice to carers of the common side effects and interactions; and

                         (iii)    consideration of the need for a formal medication review;

                (g)    check immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps and rubella and pneumococcal vaccinations) with reference to the current Australian Standard Vaccination Schedule (a National Health and Medical Research Council document) for appropriate vaccination schedules;

                (h)    check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);

                 (i)    check whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and consider formal review if required;

                (j)    consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;

               (k)    check for dysphagia and gastro‑oesophageal disease (especially for patients with cerebral palsy) and arrange for investigation or treatment as required;

                 (l)    assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication and fracture history) and arrange for investigation or treatment as required;

               (m)    for a patient diagnosed with epilepsy — review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;

                (n)    screen for thyroid disease at least every 2 years (or yearly for patients with Down syndrome);

               (o)    for a patient without a definitive aetiological diagnosis — consider referral to a genetic clinic every 5 years;

               (p)    assess or review of treatment for comorbid mental health issues;

               (q)    consider timing of puberty and management of sexual development, sexual activity and reproductive health;

                (r)    consider whether there are any signs of physical, psychological or sexual abuse.

         (3)   For subrule (1), a health assessment also includes the following:

                (a)    keeping a record of the health assessment;

               (b)    offering the patient a written report about the health assessment;

                (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; and

               (d)    offering the relevant disability professionals (if the practitioner considers it appropriate and the patient or, if appropriate, the patient’s carer, agrees) a copy of the report or extracts of the report.

29            Limitation on items 721, 723, 725, 727, 729 and 731

         (1)   This rule applies to the performances of services for a patient for whom exceptional circumstances do not exist.

         (2)   An item in this table mentioned in the following table applies in the circumstances mentioned for the item in the following table.

Item

Items of this table

Circumstances

1

721

   (a)  in the 3 months before performance of the service, a service to which item 725, 727, 729 or 731 applies has not been performed for the patient;

   (b)  not more than once in a 12 month period

2

723

   (a)  in the 3 months before performance of the service, a service to which item 727 applies has not been performed for the patient;

   (b)  not more than once in a 12 month period

3

725

   (a)  in the 3 months before performance of the service, a service to which item 721 applies has not been performed for the patient;

   (b)  not more than once in a 3 month period

4

727

   (a)  in the 3 months before performance of the service, a service to which item 723 applies has not been performed for the patient;

   (b)  not more than once in a 3 month period

5

729

   (a)  either:

         (i)   in the 3 months before performance of the service, a service to which item 725, 727 or 731 applies has not been performed for the patient; or

        (ii)   in the 12 months before performance of the service, a service has not been performed for the patient:

               (A)    by the medical practitioner who performs the service to which item 729 would, but for this item, apply; and

               (B)     for which a payment has been made under item 721 or 723;

   (b)  not more than once in a 3 month period

6

731

   (a)  in the 3 months before performance of the service, a service to which item 721, 723, 725, 727 or 729 applies has not been performed for the patient;

   (b)  not more than once in a 3 month period

         (3)   For this rule, exceptional circumstances exist for a patient if there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

30            Meaning of GP management plan

         (1)   For item 721, preparation of a GP management plan means the preparation of a comprehensive written plan describing all of the following matters:

                (a)    the patient’s health care needs, health problems and relevant conditions;

               (b)    management goals with which the patient agrees;

                (c)    actions to be taken by the patient;

               (d)    treatment and services the patient is likely to need;

                (e)    arrangements for providing the treatment and services mentioned in paragraph (d);

                (f)    arrangements to review the plan by a day specified in the plan.

         (2)   Preparation of the plan also includes:

                (a)    explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and

               (b)    recording the plan; and

                (c)    recording the patient’s agreement to the preparation of the plan; and

               (d)    offering a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

                (e)    adding a copy of the plan to the patient’s medical records.

31            Meaning of multidisciplinary discharge care plan

                For items 725 and 727, a multidisciplinary discharge care plan is a multidisciplinary care plan that is prepared for a patient before the patient is discharged from a hospital.

32            Meaning of team care arrangements

         (1)   For item 723, co‑ordinating the development of team care arrangements means a process by which the medical practitioner:

                (a)    in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner, makes arrangements for the multidisciplinary care of the patient; and

               (b)    prepares a document that describes all of the matters specified in subrule (2); and

                (c)    undertakes all of the activities specified in subrule (3).

         (2)   The matters to be described for paragraph (1) (b) are:

                (a)    treatment and service goals for the patient; and

               (b)    treatment and services that collaborating providers will provide to the patient; and

                (c)    actions to be taken by the patient; and

               (d)    arrangements to review the matters mentioned in paragraphs (a), (b) and (c) by a day specified in the document.

         (3)   The activities to be undertaken for paragraph (1) (c) are:

                (a)    explaining the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

               (b)    discussing with the patient the collaborating providers who will contribute to the development of the team care arrangements, and provide treatment and services to the patient under those arrangements; and

                (c)    recording the patient’s agreement to the development of team care arrangements; and

               (d)    giving copies of the relevant parts of the document to the collaborating providers; and

                (e)    offering a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

                (f)    adding a copy of the document to the patient’s medical records.

         (4)   In this rule:

collaborating provider is a person who:

                (a)    provides treatment or a service to a patient; and

               (b)    is not a family carer of the patient.

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.

33            Meaning of associated medical practitioner

         (1)   For items 725 and 727, an associated medical practitioner is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

         (2)   In subrule (1):

general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.

34            Meaning of review of plans

         (1)   For item 725, review of a GP management plan, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner:

                (a)    reviews the matters mentioned in subrule 49 (1) of the 2004 General Medical Services Table or subrule 59 (1), as applicable; and

               (b)    if different arrangements need to be made, makes amendments to the plan that:

                          (i)    state those new arrangements; and

                         (ii)    provide for further review of the amended plan by a date specified in the plan.

         (2)   Review of the plan also includes:

                (a)    explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review; and

               (b)    recording the patient’s agreement to the review of the plan; and

                (c)    if amendments are made to the plan:

                          (i)    offering a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

                         (ii)    adding a copy of the amended plan to the patient’s medical records.

35            Meaning of co‑ordinate a review of team care arrangements or of a multidisciplinary care plan

         (1)   For item 727, to co‑ordinate a review of team care arrangements, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner:

                (a)    in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner, reviews the matters mentioned in subrule 49 (1) of the 2004 General Medical Services Table or subrule 32 (2), as applicable; and

               (b)    if different arrangements need to be made, makes amendments to the document mentioned in paragraph 32 (1) (b), or to the plan, that:

                          (i)    state those new arrangements; and

                         (ii)    provide for the review of the amended document or plan by a date specified in the document or plan.

         (2)   Co‑ordinating a review of team care arrangements or of a multidisciplinary care plan also includes:

                (a)    explaining the steps involved in the review to 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 the review of the team care arrangements or the plan; and

                (c)    giving copies of the relevant parts of the amended document mentioned in paragraph (1) (b), or the amended plan, to the collaborating providers; and

               (d)    offering a copy of the amended document or plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

                (e)    adding a copy of the amended document or plan to the patient’s medical records.

         (3)   In this rule:

collaborating provider is a person who:

                (a)    provides treatment or a service to a patient; and

               (b)    is not a family carer of the patient.

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.

36            Meaning of contribute to a multidisciplinary care plan for items 729 and 731

         (1)   For items 729 and 731, to contribute to a multidisciplinary care plan or to the review of a plan includes:

                (a)    preparing part of the plan or amendments to the plan, and adding a copy of that part or those amendments to the patient’s medical records; or

               (b)    giving advice to a person who prepares or reviews the plan, and recording in writing, on the patient’s medical records, any advice provided to such a person.

         (2)   In items 729 and 731 and subrule (1):

multidisciplinary care plan means a written plan that:

                (a)    is prepared for a patient by:

                          (i)    a medical practitioner, in consultation with 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and 1 of whom may be another medical practitioner; or

                         (ii)    a collaborating provider (other than a medical practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and

               (b)    describes, at least, treatment and services to be provided to the patient by the collaborating providers.

         (3)   In this rule:

collaborating provider:

                (a)    is a person who:

                          (i)    provides treatment or a service to a patient; and

                         (ii)    is not a family carer of the patient; and

               (b)    includes a medical practitioner.

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.

37            Service by certain medical practitioners — items 729 to 866

         (1)   Items 729 to 866 apply only to a service provided 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.

38            Application of items in Group A15 to certain patients only

         (1)   An item in this table mentioned in the following table applies only to a service for 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 described in column 3 of the following table.

 

Item

Items in this table

Description of patient

1

740, 742, 744, 759, 762, 765

The patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility

2

721, 725

The patient:

   (a)  is not an in‑patient of a hospital or a care recipient in a residential aged care facility; or

   (b)  is an in‑patient and a private patient of a hospital

3

746, 749, 757, 768, 771, 773

The patient:

   (a)  is an in‑patient of a hospital; and

   (b)  is not a care recipient in a residential aged care facility

4

723, 727

The patient:

   (a)  requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and

   (b)  either:

         (i)   is not an in‑patient of a hospital or a care recipient in a residential aged care facility; or

        (ii)   being an in‑patient and a private patient of a hospital

5

729

The patient:

   (a)  requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and

   (b)  is not a care recipient in a residential aged care facility

6

734, 736, 738, 775, 778, 779

The patient:

   (a)  is a care recipient in a residential aged care facility; and

   (b)  is not an in‑patient of a hospital

7

731

The patient:

   (a)  requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and

   (b)  is a care recipient in a residential aged care facility

         (2)   In this rule:

collaborating provider is a person who:

                (a)    provides treatment or a service to a patient; and

               (b)    is not a family carer of the patient.

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.

39            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 42) 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.

40            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.

41            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.

42            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.

43            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 39, 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 39, 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.

44            Meaning of co‑ordinate in item 880

                For item 880, co‑ordinating a case conference means undertaking all of the following activities in relation to a case conference:

                (a)    co‑ordinating and facilitating the case conference;

               (b)    resolving any disagreement or conflict to enable the members of the case conference team giving care and service to the patient to agree on the outcomes to be achieved;

                (c)    identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;

               (d)    recording the input of each member and the outcome of the conference.

45            Meaning of case conference team in item 880

         (1)   For item 880, a case conference team:

                (a)    includes a specialist, or consultant physician, in the practice of his or her specialty of geriatric or rehabilitation medicine; and

               (b)    includes at least 2 other allied health professionals, each of whom provides a different kind of care or service to the patient and is not a medical practitioner or family carer of the patient; and

                (c)    may include the patient, a family carer of the patient or a medical practitioner.

Example

Examples of persons who, for paragraph (b), may be included in a team are:

·      dieticians

·      mental health workers

·      occupational therapists

·      pharmacists

·      physiotherapists

·      podiatrists

·      psychologists

·      social workers

·      speech pathologists.

         (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            Application of item 880

         (1)   Item 880 applies only if:

                (a)    the attendance is by a specialist, or consultant physician, in the specialty of geriatric medicine or rehabilitation medicine for the purposes of the Act; and

               (b)    the attendance is on a patient who:

                          (i)    is an admitted patient of a hospital; and

                         (ii)    is not a care recipient in a residential aged care facility; and

                         (iii)    is being provided with 1 of the following types of specialist care:

                                   (A)     geriatric evaluation and management;

                                   (B)     rehabilitation care.

         (2)   In this rule:

geriatric evaluation and management means care provided to a patient with a disability or psychosocial problem for the purpose of maximising the patient’s health status or optimising the patient’s living arrangements.

rehabilitation care means care provided to a patient with an impairment or disability for the purpose of improving the patient’s functional status.

47            Meaning of living in a community setting in item 900

                For item 900, a patient is living in a community setting if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility.

48            Meaning of residential medication management review in item 903

         (1)   For item 903, a residential medication management review is a collaborative service provided by a medical practitioner and a pharmacist to review the medication management needs of a permanent resident of a residential aged care facility.

         (2)   A medical practitioner’s involvement in a residential medication management review includes all of the following:

                (a)    discussing the proposed review with the resident and seeking the resident’s consent to the review;

               (b)    collaborating with the reviewing pharmacist about the pharmacist’s involvement in the review;

                (c)    providing input from the resident’s most recent comprehensive medical assessment or, if such an assessment has not been undertaken, providing relevant clinical information for the review and for the resident’s records;

               (d)    subject to subrule (4), participating in a post‑review discussion (either face‑to‑face or by telephone) with the pharmacist to discuss the outcomes of the review including:

                          (i)    the findings of the review; and

                         (ii)    medication management strategies; and

                         (iii)    means to ensure that the strategies are implemented and reviewed, including any issues for implementation and follow‑up;

                (e)    developing or revising the resident’s medication management plan after discussion with the reviewing pharmacist, and finalising the plan after discussion with the resident.

         (3)   A medical practitioner’s involvement in a residential medication management review also includes:

                (a)    offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate); and

               (b)    providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and

                (c)    discussing the plan with nursing staff if necessary.

         (4)   A post‑review discussion is not required if:

                (a)    there are no recommended changes to the resident’s medication management arising out of the review; or

               (b)    any changes are minor in nature and do not require immediate discussion; or

                (c)    the pharmacist and medical practitioner agree that issues arising out of the review should be considered in an enhanced primary care case conference.

49            Meaning of amount under rule 49 in certain items

                In this table:

amount under rule 49, for an item mentioned in the following table, means the sum of:

                (a)    the fee mentioned in column 3 for the item; and

               (b)    either:

                          (i)    if not more than 6 patients are attended at a single attendance — the amount mentioned in column 4 for the item, divided by the number of patients attended; or

                         (ii)    if more than 6 patients are attended at a single attendance — the amount mentioned in column 5 for the item.

 

Item

Items of this table

Fee

Amount if not more than 6 patients (to be divided by the number of patients)

Amount if more than 6 patients

1

2503

The fee for item 2501

$22.95

$1.70

2

2506

The fee for item 2504

$22.95

$1.70

3

2509

The fee for item 2507

$22.95

$1.70

4

2518

The fee for item 2517

$22.95

$1.70

5

2522

The fee for item 2521

$22.95

$1.70

6

2526

The fee for item 2521

$22.95

$1.70

7

2547

The fee for item 2546

$22.95

$1.70

8

2553

The fee for item 2552

$22.95

$1.70

9

2559

The fee for item 2558

$22.95

$1.70

10

2723

The fee for item 2721

$22.95

$1.70

11

2727

The fee for item 2725

$22.95

$1.70

50            Application of items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616

                Items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616 do not apply in conjunction with any of items 10994, 10995, 10998 and 10999.

51            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 11 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 a cycle of care of a patient with established diabetes mellitus if the attendance completes a series of attendances that involve, over a period of at least 11 months and up to 13 months, (the current cycle), the following:

                (a)    at least 1 assessment of the patient’s diabetes control, by measuring the patient’s HbA1c;

               (b)    subject to subrule (3), if the patient has not had a comprehensive eye examination in the cycle of care ending 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)    2 further measurements of the patient’s weight with each measurement being taken at least 5 months after the previous measurement;

                (e)    2 measurements of the patient’s blood pressure, taken at least 5 months but not more than 7 months apart;

                (f)    subject to subrule (3), 2 examinations of the patient’s feet, carried out at least 5 months but not more than 7 months apart;

                (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.

         (3)   For a patient with established diabetes mellitus who is mentioned in the following table, the minimum requirements of a cycle of care for the patient in relation to paragraphs (2) (b) and (f) may be completed as set out in the table.

 

Item

Patient

How minimum requirements completed

1

A patient who is blind

Without an eye examination

2

A patient who has sight in only 1 eye

Examination of that eye

3

A patient does not have any feet

Without a foot examination

4

A patient who has only 1 foot

Examination of that foot

52            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 Cycle of Care if the attendance completes a series of attendances that involve:

                (a)    documented diagnosis and documented assessment of level of asthma control and severity of asthma; and

               (b)    at least 2 asthma‑related consultations within 12 months (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation and includes the review mentioned in subparagraph (iv)) that involve the following for a patient with moderate to severe asthma:

                          (i)    a review of the patient’s use of and access to asthma related medication and devices;

                         (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 of asthma self‑management education to the patient;

                        (iv)    at the review consultation:

                                   (A)     a review of the patient’s written or documented asthma action plan; and

                                   (B)     if necessary, adjustment of that plan.

53            Application of Group A24

         (1)   Subgroups 1 and 2 of Group A24 apply only if the attendance is by a medical practitioner who is recognised as a specialist, or consultant physician, in the specialty of pain medicine for the purposes of the Act.

         (2)   Subgroups 3 and 4 of Group A24 apply only if the attendance is by a medical practitioner who is recognised as a specialist, or consultant physician, in the specialty of palliative medicine for the purposes of the Act.

54            Meaning of expressions used in rules 55 to 57 and Group A20

         (1)   The following expressions, when used in rules 55 to 57or an item of Group A20, have the following meanings:

3 Step Mental Health Process means a service provided to a patient under item 2574, 2575, 2577, 2578, 2704, 2705, 2707 or 2708 of the Health Insurance (General Medical Services Table) Regulations 2006 as in force on 30 April 2007.

mental 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, attention is drawn to the Diagnostic and Management Guidelines for Mental 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.

         (2)   For rules 56 and 57, exceptional circumstances exist in relation to a service mentioned in an item for a patient if performance of the service for the patient is necessitated by:

                (a)    a significant change in the patient’s clinical condition; or

               (b)    a significant change in the patient’s care circumstances.

55            GP Mental Health Care Plans (Subgroup 1 of Group A20)

         (1)   For item 2710, preparation of a GP mental health care plan means the preparation of a comprehensive written plan, in consultation with a patient (and, if subrule (6) applies, the patient’s carer), that includes:

                (a)    assessment of the patient’s mental disorder, including administration of an outcome measurement tool (except if considered clinically inappropriate); and

               (b)    formulation or diagnosis or both formulation and diagnosis of the mental disorder; and

                (c)    treatment goals with which the patient agrees; and

               (d)    any actions to be taken by the patient; and

                (e)    a plan for crisis intervention and/or for relapse prevention, if appropriate; and

                (f)    referral and treatment options for the patient; and

                (g)    arrangements for providing the treatment and services referred to in paragraph (f); and

                (h)    arrangements to review the plan.

         (2)   For paragraph (1) (f), the referral and treatment options for a patient include:

                (a)    support services; and

               (b)    psychiatric services; and

                (c)    subject to the applicable limitations:

                          (i)    psychological therapies provided by a clinical psychologist (items 80000* to 80020*); and

                         (ii)    focussed psychological strategy services provided by a medical practitioner who is qualified in the way mentioned in paragraph 57 (1) (b) to provide those services (items 2721 to 2727); and

                         (iii)    focussed psychological strategy services provided by an allied mental health professional (items 80100* to 80170*).

Note   Asteriked items relate to a health service specified in the Health Insurance (Allied Health and Dental Services) Determination 2007.

         (3)   Preparation of the plan also includes:

                (a)    explaining to the patient (and, if subrule (6) applies, the patient’s carer) the steps involved in preparing the plan; and

               (b)    recording the plan; and

                (c)    recording the patient’s agreement to the preparation of the plan; and

               (d)    offering the patient (and, if subrule (6) applies, the patient’s carer):

                          (i)    a copy of the plan; and

                         (ii)    suitable education about the mental disorder; and

                (e)    adding a copy of the plan to the patient’s medical records.

         (4)   For item 2712, review of a GP mental health care plan means a process by which the medical practitioner:

                (a)    reviews the matters mentioned in subrule (1) as applicable; and

               (b)    checks, reinforces and expands any education given under the plan; and

                (c)    prepares a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and

               (d)    re‑administers the outcome measurement tool used in the assessment mentioned in paragraph (1) (a) (except if considered clinically inappropriate); and

                (e)    if different arrangements need to be made, makes amendments to the plan that state those new arrangements.

         (5)   Review of the plan also includes:

                (a)    explaining to the patient (and, if subrule (6) applies, the patient’s carer) the steps involved in the review; and

               (b)    recording the patient’s agreement to the review of the plan; and

                (c)    if amendments are made to the plan:

                          (i)    offering a copy of the amended plan to the patient (and, if subrule (6) applies, the patient’s carer); and

                         (ii)    adding a copy of the amended plan to the patient’s medical records.

         (6)   This subrule applies if:

                (a)    a patient has a carer; and

               (b)    the practitioner who is preparing or reviewing a GP mental health care plan considers it appropriate to involve the carer; and

                (c)    the patient agrees to the carer being involved.

56            Application of items in Subgroup 1 of Group A20

         (1)   Items 2710, 2712, 2713 apply only in relation to a patient with a mental disorder.

         (2)   Items 2710 and 2712 apply to:

                (a)    a patient in the community; and

               (b)    a private in‑patient (including a private in‑patient who is a resident of an aged care facility) being discharged from hospital.

         (3)   Item 2713 applies only as a surgery consultation.

         (4)   Unless exceptional circumstances exist, item 2710 is not applicable:

                (a)    in association with a service to which any of items 2713 or 734 to 779 apply; or

               (b)    more than once in a 12 month period for a particular patient; or

                (c)    within 12 months of the provision of a service in a 3 Step Mental Health Process (items 2574, 2575, 2577, 2578, 2704, 2705, 2707 and 2708); or

               (d)    within 3 months following the provision of a service to which item 2712 applies.

         (5)   Item 2712 applies only if 1 of the following services has been provided to the patient in the previous 12 months:

                (a)    a GP Mental Health Care Plan (item 2710);

               (b)    a Review of a GP Mental Health Care Plan (item 2712);

                (c)    a psychiatrist assessment and management plan (item 291).

         (6)   Item 2712 is not applicable in association with a service to which any of items 2713 or 734 to 779 apply.

         (7)   Unless exceptional circumstances exist, item 2712 is not applicable:

                (a)    more than once in a 3 month period; or

               (b)    within 4 weeks following provision of a GP Mental Health Care Plan item (item 2710).

         (8)   Item 2713:

                (a)    applies only to an attendance of at least 20 minutes duration; and

               (b)    does not apply in association with a service to which item 2710 or 2712 applies.

57            Focussed psychological strategies

         (1)   An item in Subgroup 2 of Group A20 applies only to a service that:

                (a)    is clinically indicated under a 3 Step Mental Health Process, GP Mental Health Care Plan or a Psychiatrist Assessment and Management Plan; and

               (b)    is provided by a medical practitioner:

                          (i)    whose name is entered in the register maintained by the Medicare Australia CEO under section 28 of the Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

                         (ii)    who is identified in the register as a practitioner who can provide services to which Subgroup 2 of 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 Subgroup 2 of 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 Subgroup 2 of Group A20 does not apply to:

                (a)    a service that:

                          (i)    is provided to a patient who has already been provided, in the calender year, with a group of 6 other services to which any of the items in that Subgroup  applies; and

                         (ii)    is provided before the medical practitioner managing the 3 Step Mental Health Process, GP Mental Health Care Plan or Psychiatrist Assessment and Management Plan has conducted a review and has noted in the patient’s records a recommendation that the patient have additional sessions of psychological strategies in the calender year; or

               (b)    a service that is provided to a patient who has already been provided, in the calender year, with 12 (or, if exceptional circumstances exist, 18) other services to which any of items in that Subgroup applies.

         (3)   In Group A20, a reference to focussed psychological strategies is a reference to any of the following mental health care management strategies that have 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.

58            Application of Group A28

                An item in Group A28 applies only to a service provided in the course of a personal attendance by a medical practitioner.

59            Item 4001

         (1)   A service to which item 4001 applies must not be provided by a medical practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

         (2)   Item 4001 does not apply if a patient has already been provided, for the same pregnancy, with 3 services to which that item or item 81000*, 81005* or 81010* applies.

Note   Asterisked items relate to a health service specified in the Health Insurance (Allied Health and Dental Services) Determination 2007.

         (3)   A reference in item 4001 to non‑directive pregnancy support counselling is a reference to counselling provided by a medical practitioner to a woman in which:

                (a)    information and issues relating to pregnancy are discussed; but

               (b)    the medical practitioner does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.

         (4)   A service to which item 4001 applies may be used to address any pregnancy‑related issue.

60            Meaning of outer metropolitan specialist trainee in items 5906, 5908, 5910 and 5912

                In items 5906, 5908, 5910 and 5912:

outer metropolitan specialist trainee means:

                (a)    a medical practitioner who is currently enrolled in and undertaking a training course in an approved specialist college listed as a specified body in Schedule 5 to the Health Insurance Regulations 1975 (excluding the Royal Australian College of General Practitioners); or

               (b)    a practitioner who is undertaking a placement as part of the structured training program of the approved specialist college that provides experience not available in teaching hospitals:

                          (i)    as part of an accredited ‘advanced’ training placement, or a training placement approved by the Department, that fully counts towards training time and other formal requirements; and

                         (ii)    as a college trainee with access to medicare benefits that is limited to attendances provided at a practice nominated by the approved specialist college for a specified time period.

61            Application of items 1 to 10943

                An item in the range 1 to 10943 does not apply to the service described in that item if the service is provided at the same time as, or in connection with, any of the services mentioned in Part 4 of this table.

62            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, 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, 16514 and 17610 to 17690.

63            Application of items 5000 to 5267

                An item in the range 5000 to 5267 applies only to a professional attendance that is provided in an after‑hours period.

64            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.

65            Application of item 10988

         (1)   In this rule and item 10988:

general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.

immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.

registered Aboriginal health worker means a person registered as an Aboriginal health worker under the Health Practitioners Act (NT) who is employed by, or whose services are otherwise retained by, a general practice or health service in the Northern Territory in relation to which the Minister has made a direction under subsection 19 (2) of the Act.

         (2)   Item 10988 applies to an immunisation provided to a person by a registered Aboriginal health worker only if:

                (a)    the registered Aboriginal health worker is appropriately qualified and trained to provide immunisations to persons; and

               (b)    the medical practitioner under whose supervision the immunisation is provided retains responsibility for the health, safety and clinical outcomes of the person.

         (3)   If the cost of the vaccine supplied in connection with a service described in item 10988 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that vaccine.

66            Application of item 10989

         (1)   In this rule and item 10989:

registered Aboriginal health worker has the meaning given by subrule 65 (1).

         (2)   Item 10989 applies to the treatment of a person’s wound (other than normal aftercare) provided by a registered Aboriginal health worker only if:

                (a)    the registered Aboriginal health worker is appropriately qualified and trained to treat wounds; and

               (b)    the medical practitioner under whose supervision the treatment is provided has conducted an initial assessment of the person; and

                (c)    the registered Aboriginal health worker has been instructed by the medical practitioner in relation to the treatment of the wound; and

               (d)    the medical practitioner retains responsibility for the health, safety and clinical outcomes of the person.

67            Application of items 10990, 10991 and 10992

         (1)   If the medical service described in item 10991 is provided to a person, either that item or 10990, but not both those items, applies to the service.

         (2)   If the medical service described in item 10992 is provided to a person, either that item or 10990, but not both those items, applies to the service.

         (3)   If item 10990, 10991 or 10992 applies to a medical service, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.

         (4)   For items 10990, 10991 and 10992:

bulk‑billed, in relation to a medical service, means:

                (a)    a medicare benefit is payable to a person in relation to the service; and

               (b)    under an agreement entered into under section 20A of the Act:

                          (i)    the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

                         (ii)    the medical practitioner accepts the assignment in full payment of his or her fee for the service provided.

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.

unreferred service means a medical service provided to a person by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.

         (5)   For items 10991 and 10992:

ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.

eligible area means:

                (a)    a regional, rural or remote area; or

               (b)    Tasmania; or

                (c)    a geographical area included in any of the following SSD spatial units:

                          (i)    Beaudesert Shire Part A;

                         (ii)    Belconnen;

                         (iii)    Darwin City;

                        (iv)    Eastern Outer Melbourne;

                         (v)    East Metropolitan;

                        (vi)    Frankston City;

                        (vii)    Gosford‑Wyong;

                       (viii)    Greater Geelong City Part A;

                        (ix)    Gungahlin‑Hall;

                         (x)    Ipswich City (Part in BSD);

                        (xi)    Litchfield Shire;

                        (xii)    Melton‑Wyndham;

                       (xiii)    Mornington Peninsula Shire;

                       (xiv)    Newcastle;

                       (xv)    North Canberra;

                       (xvi)    Palmerston‑East Arm;

                      (xvii)    Pine Rivers Shire;

                     (xviii)    Queanbeyan;

                       (xix)    South Canberra;

                       (xx)    South Eastern Outer Melbourne;

                       (xxi)    Southern Adelaide;

                      (xxii)    South West Metropolitan;

                     (xxiii)    Thuringowa City Part A;

                     (xxiv)    Townsville City Part A;

                      (xxv)    Tuggeranong;

                     (xxvi)    Weston Creek‑Stromlo;

                    (xxvii)    Woden Valley;

                   (xxviii)    Yarra Ranges Shire Part A; or

               (d)    the geographical area included in the SLA spatial unit of Palm Island (AC).

practice location, in relation to the provision of a medical service, means the place of practice in relation to which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Medicare Australia CEO.

regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

68            Application of item 10993

         (1)   For item 10993:

enrolled nurse means a person who:

                (a)    holds a current practising certificate as a nurse issued by a State or Territory regulatory authority; and

               (b)    is licensed to provide nursing care under the supervision of a registered nurse.

general practice has the meaning given by subrule 65 (1).

immunisation has the meaning given by subrule 65 (1).

practice nurse means a registered nurse or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice.

registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989.

         (2)   Item 10993 applies to an immunisation provided to a person by a practice nurse only if:

                (a)    the practice nurse is appropriately qualified and trained to provide immunisations to persons; and

               (b)    the medical practitioner under whose supervision the immunisation is provided retains responsibility for the health, safety and clinical outcomes of the person.

         (3)   If the cost of the vaccine supplied in connection with a service described in item 10993 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that vaccine.

69            Application of items 10994 and 10995

         (1)   For items 10994 and 10995:

enrolled nurse has the meaning given by subrule 68 (1).

general practice has the meaning given by subrule 65 (1).

practice nurse has the meaning given by subrule 65 (1).

preventive check:

                (a)    includes at least 1 of the following:

                          (i)    a check for sexually transmitted infections (including chlamydia);

                         (ii)    taking of a sexual and reproductive history;

                         (ii)    advice on contraception;

                         (iii)    breast awareness education;

                        (iv)    advice on post natal issues;

                         (v)    continence advice and education; and

               (b)    may also include a smoking, nutrition, alcohol and physical activity (SNAP) behavioural risk factor assessment, and blood pressure measurement.

         (2)   Items 10994 and 10995 apply only if:

                (a)    the practice nurse is appropriately qualified and trained to perform the services provided; and

               (b)    the medical practitioner under whose supervision the treatment is provided retains responsibility for clinical outcomes and for the health and safety of the person.

         (3)   Items 10994 and 10995 do not apply to a service that is provided to a person in conjunction with a service to which any of items 10998, 10999, 2497 to 2509 and 2598 to 2616 apply.

         (4)   Items 10994 is not applicable in conjunction with a service to which item 10995 applies.

70            Application of item 10996

         (1)   For item 10996:

enrolled nurse has the meaning given by subrule 68 (1).

general practice has the meaning given by subrule 65 (1).

practice nurse has the meaning given by subrule 65 (1).

         (2)   Item 10996 applies to the treatment of a person’s wound (other than normal aftercare) provided by a practice nurse only if:

                (a)    the practice nurse is appropriately qualified and trained to treat wounds; and

               (b)    the medical practitioner under whose supervision the treatment is provided has conducted an initial assessment of the person; and

                (c)    the practice nurse has been instructed by the medical practitioner in relation to the treatment of the wound; and

               (d)    the medical practitioner retains responsibility for the health, safety and clinical outcomes of the person.

71            Meaning of expressions used in item 10997

                In item 10997:

GP management plan means a plan under item 721 or 725.

multidisciplinary care plan means a plan under items 729 or 731.

person with a chronic disease means a person who has a care plan under items 721, 723, 725, 725, 729 or 731.

practice nurse has the meaning given by subrule 68 (1).

registered Aboriginal health worker has the meaning given by subrule 65 (1).

team care arrangements means a plan under item 723 or 727.

72            Application of items 10998 and 10999

         (1)   For this rule and items 10998 and 10999:

practice nurse has the meaning given by subrule 68 (1).

         (2)   Items 10998 and 10999 apply to the taking of a cervical smear from a person by a practice nurse only if:

                (a)    the practice nurse is appropriately qualified and trained to take a cervical smear; and

               (b)    the medical practitioner under whose supervision the smear is taken retains responsibility for the health, safety and clinical outcomes of the person.

73            Limitation on certain items

         (1)   For any particular patient, each of items 291, 293, 359, 10943 and 45019 is applicable not more than once in a 12 month period.

         (2)   For any particular patient, item 10942 is applicable not more than twice in a 12 month period.

         (3)   For any particular patient, each of items 2946 to 3000 and 3032 to 3093 is applicable not more than 5 times in a 12 month period.

         (4)   For any particular patient, each of items 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928 and 10929 is applicable not more than once in a 36 month period.

         (5)   For any particular patient, item 13104 is applicable not more than 12 times in a 12 month period.

74            Application of items 10900, 10940 and 10941

         (1)   A service described in item 10900 applies to any particular patient only if the patient has not received a service described in item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 in the previous 24 months.

         (2)   A service described in item 10940 applies to any particular patient not more than twice in any 12 month period and includes a service described in item 10941.

         (3)   A service described in item 10941 applies to any particular patient not more than twice in any 12 month period and includes a service described in item 10940.

75            Application of items 10931, 10932 and 10933

         (1)   If item 10931, 10932 or 10933 applies, the fee mentioned in that item applies in addition to the fee mentioned in any other item in this table that applies to the service.

         (2)   The fee charged for the following must not exceed $125.50:

                (a)    the fee mentioned in item 10931, 10932 or 10933 if it is not bulk‑billed;

               (b)    the fee mentioned in any other item in this table that applies to the service if it is not bulk‑billed;

                (c)    the fee charged by an optometrist for the service.

         (3)   For items 10931, 10932 and 10933:

bulk‑billed, for a medical service, means:

                (a)    a medicare benefit is payable to a person in relation to the service; and

               (b)    under an agreement entered into under section 20A of the Act:

                          (i)    the person assigns, to the medical practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

                         (ii)    the medical practitioner accepts the assignment in full payment of his or her fee for the service provided.

76            Limitation of items 10943, 16590, 18360, 18364 and 50303

         (1)   A service described in item 10943 does not apply to a service used to assess learning difficulties or learning disabilities.

         (2)   A service described in item 16590 is applicable not more than once in a pregnancy that has progressed beyond 20 weeks.

         (3)   A service described in items 18360 and 18364 is applicable to the first 4 treatments, not exceeding 2 for each limb, on any day.

         (4)   A service described in item 50303 is applicable once in any 12 month period for each limb.

77            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)    for an assessment for qualification as a qualified adult sleep medicine practitioner — the Advanced Training Program in Adult Sleep Medicine; and

               (b)    for 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)    for an assessment for qualification as a qualified adult sleep medicine practitioner — adult sleep medicine; and

               (b)    for an assessment for qualification as a qualified paediatric sleep medicine practitioner — paediatric sleep medicine.

78            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.

79            Meaning of treatment cycle of a patient

                In rule 80 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.

80            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.

81            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.

82            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.

83            Application of items 14227, 14230, 14233, 14236, 14239 and 14242

                Items 14227, 14230, 14233, 14236, 14239 and 14242 apply to a service in relation to a patient only if:

                (a)    the patient has:

                          (i)    chronic spasticity of cerebral origin; or

                         (ii)    chronic spasticity caused by multiple sclerosis, spinal cord injury or spinal cord disease; and

               (b)    oral antispastic agents have failed or have caused the patient to experience unacceptable side effects; and

                (c)    an authority has been given by Medicare Australia to provide the service to the patient.

84            Injection of immunomodulating agent

         (1)   Item 14245 applies only to a service provided by a medical practitioner who is registered by the Medicare Australia CEO 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 an immunomodulating agent.

         (2)   Item 14245 is applicable once only on the same day.

85            Meaning of amount under rule 86 in certain items

                In this table:

amount under rule 86, for an item mentioned in the following table, means the sum of:

                (a)    the fee mentioned in column 3 for the item; and

               (b)    the amount mentioned in column 4 for each field separately treated in excess of 1.

 

Item

Items of this table

Fee

Amount for each field separately treated in excess of 1

1

15003

The fee for item 15000

$15.45

2

15009

The fee for item 15006

$16.75

3

15103

The fee for item 15100

$17.00

4

15109

The fee for item 15106

$20.50

5

15115

The fee for item 15106

$42.70

6

15214

The fee for item 15211

$28.80

7

15230, 15233, 15236, 15239, 15242, 15260, 15263, 15266, 15269, 15272

$53.90

$34.25

86            Meaning of approved site in items 15338 and 37220

                For items 15338 and 37220, approved site, for 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.

87            Application of items 15556, 15559 and 15562

                A service described in item 15556, 15559 or 15562 applies only if:

                (a)    each gross tumour target, clinical target, planning target and organ at risk specified in the prescription is rendered as a volume; and

               (b)    each organ at risk is nominated as a planning dose goal or constraint; and

                (c)    each organ at risk is specified in the prescription as a dose goal or constraint; and

               (d)    dose volume histograms are generated, approved and recorded with the plan; and

                (e)    a CT image volume dataset is required for the relevant region to be planned and treated; and

                (f)    the CT image is required to be suitable for the generation of quality digitally reconstructed radiographic images.

88            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.

89            Meaning of amount under rule 89 in items 16633 and 16636

         (1)   In item 16633, amount under rule 89 means, for a second or subsequent foetus, the amount that is equal to 50% of the amount of the fee mentioned in items 16606, 16609, 16612, 16615 and 16627 for services provided in relation to the multiple pregnancy.

         (2)   In item 16636, amount under rule 89 means, for a second or subsequent foetus, the amount that is equal to 50% of the amount of the fee mentioned in items 16600, 16603, 16618, 16621 and 16624 for services provided in relation to the multiple pregnancy.

90            Meaning of amount under rule 90 in items 18219 and 18227

         (1)   In item 18219, amount under rule 90 means an amount equal to the sum of:

                (a)    the fee for item 18216; and

               (b)    $17.20 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 90 means an amount equal to the sum of:

                (a)    the fee for item 18226; and

               (b)    $25.80 for each additional period of 15 minutes, and part of a period of 15 minutes, of continuous attendance beyond the first hour of attendance.

91            Injection of botulinum toxin

         (1)   Each of items 18350 to 18373 applies only to a service provided by a medical practitioner who is registered by the Medicare Australia CEO 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.

         (2)   If the cost of the botulinum toxin injection supplied in connection with a service described in each of items 18350 to 18373 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that toxin.

92            Meaning of expressions used in rule 93 and item 16400

                In rule 93 and item 16400:

midwife means a person:

                (a)    who is registered, and holds a current practising certificate issued by a State or Territory regulatory authority, as a midwife; and

               (b)    who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

nurse means a person:

                (a)    who is registered, and holds a current practising certificate issued by a State or Territory regulatory authority, as a registered nurse or enrolled nurse; and

               (b)    who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

practice location has the same meaning as in subrule 67 (5)).

regional, rural or remote area has the same meaning as in subrule 67 (5)).

registered Aboriginal Health Worker means a person:

                (a)    who is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal Health Worker; and

               (b)    who is employed by, or whose services are otherwise retained by, a medical practitioner, a practice operated by a medical practitioner or a health service in relation to which the Minister has made a direction under subsection 19 (2) of the Act.

93            Application of item 16400

         (1)   Item 16400 applies to an antenatal service provided to a patient by a midwife, nurse or registered Aboriginal Health Worker only if:

                (a)    the nurse or registered Aboriginal Health Worker has the appropriate training and skills to perform an antenatal service; and

               (b)    the medical practitioner under whose supervision the antenatal service is provided retains responsibility for clinical outcomes and for the health and safety of the patient; and

                (c)    the midwife, nurse or registered Aboriginal Health Worker complies with relevant legislative or regulatory requirements regarding the provision of the antenatal service in the State or Territory where the service is provided.

         (2)   Item 16400 is not applicable in conjunction with another antenatal attendance item for the same patient, on the same day by the same practitioner.

         (3)   Item 16400 is not applicable in conjunction with items 10990, 10991 or 10992.

         (4)   For any particular patient, item 16400 is applicable not more than 10 times in a 9 month period.

94            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).

95            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.

96            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)    for 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)    for 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)    for 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.

97            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.

98            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.

99            Meaning of amount under rule 99 in items 25025, 25030 and 25050

         (1)   For item 25025, amount under rule 99 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 99 means the amount that is equal to 50% of the sum of:

                (a)    the fee specified in the item in the range 23010 to 24136 that applies to the assistance; and

               (b)    if any of items 25000 to 25015 applies to the assistance — the fee specified in that item; and

                (c)    if any of items 25200 to 25205 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 99 means the amount that is equal to 50% of the sum of:

                (a)    the fee specified in item 22060; 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 or 22065 to 22075 is performed in association with the perfusion — the fee specified in that item.

100         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.

101         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.

102         Meaning of amount under rule 102 in items 25200 and 25205

                For each of items 25200 and 25205, amount under rule 102, means the sum of:

                (a)    $89.50; 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.

103         Group T8 services may be provided by a specialist trainee

         (1)   An item in Group T8 applies to a medical service provided by:

                (a)    a medical practitioner; or

               (b)    a specialist trainee under the direct supervision of a medical practitioner.

         (2)   For paragraph (1) (b), a medical service provided by a specialist trainee is taken to have been provided by the supervising medical practitioner.

         (3)   In this rule:

accredited specialist training placement means a placement in a specialist training position:

                (a)    accredited by the Royal Australasian College of Surgeons; and

               (b)    allowing a participant to undertake part of a training program leading to the attainment of a Fellowship of the Royal Australasian College of Surgeons.

specialist trainee means a medical practitioner who is:

                (a)    enrolled in and undertaking a training course with the Royal Australasian College of Surgeons; or

               (b)    undertaking an accredited specialist training placement, with access to Medicare benefits, that is limited to attendances provided at a practice nominated by the Royal Australasian College of Surgeons for a specified time period.

104         Meaning of amount under rule 104 in item 30001

                In item 30001, amount under rule 104 means 50% of the specified fee that would normally apply for a surgical procedure if the surgical procedure had not been discontinued before completion.

105         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.

106         Meaning of amount under rule 106 in item 31340

                In item 31340, amount under rule 106, for 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.

107         Application of items 30688, 30690, 30692 and 30694

                Item 30688, 30690, 30692 or 30694 applies to a service only if the provider makes a record of the findings of the ultrasound imaging in the patient’s notes.

108         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 Medicare Australia CEO 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.

109         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 Medicare Australia CEO 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.

110         Meaning of foreign body in items 35360 to 35363

                For items 35360, 35361, 35362 and 35363, foreign body does not include an instrument inserted for the purpose of a service being rendered.

111         Application of items 35404, 35406 and 35408

         (1)   Items 35404, 35406 and 35408 do not apply to selective internal radiation therapy provided in combination with systemic chemotherapy using any drugs other than 5 fluorouracil (5FU) and leucovorin.

         (2)   Item 35404 applies only to a service provided by a medical practitioner recognised as a specialist, or consultant physician, in the specialty of nuclear medicine or radiation oncology for the purposes of the Act.

112         Application of items 30299 and 30300

                A service described in items 30299 and 30300 is applicable if only pre‑operative lymphoscinitigraphy is used because the patient is allergic to lymphotrophic dye.

113         Application of items 30440, 30451, 30492 and 30495

                A service described in item 30440, 30451, 30492 or 30495 does not include imaging.

Note   The imaging services associated with these services are described in the diagnostic imaging services table.

114         Application of item 35412

         (1)   Intra‑operative imaging is taken to be part of the service associated with the coiling of an aneurysm and cannot be charged in addition to item 35412.

         (2)   Pre‑operative diagnostic imaging, including aftercare, under item 60009, 60072, 60075 or 60078 of the diagnostic imaging services table may be separately claimed.

115         Application of items 38365, 38368 and 38654

                A service described in item 38365, 38368 or 38654 applies to any particular patient only if:

                (a)    the patient:

                          (i)    has moderate to severe chronic heart failure (New York Heart Association (NYHA) class III or IV) despite optimised medical therapy; and

                         (ii)    has sinus rhythm; and

                         (iii)    has a left vernicular ejection fraction of 35% or less; and

                        (iv)    has a QRS duration of 120 milliseconds or more; or

               (b)    the patient satisfied the requirements mentioned in paragraph (a) immediately before the insertion of a cardiac resynchronisation therapy device and transvenous left ventricular electrode.

116         Application of items 38470 to 38766

                An item in the range 38470 to 38766 must be performed using open exposure or minimally invasive surgery unless otherwise stated in the item.

117         Meaning of amount under rule 117 in certain items

                In item 44376 (reamputation), amount under rule 117 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.

118         Meaning of maxilla in certain items

                In items 45720 to 45752 and 52342 to 52375, maxilla includes the zygoma.

119         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.

120         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.

121         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 before 1 November 2004 for the definition of professional service in subsection 3 (1) of the Act.

122         Meaning of amount under rule 122 in items 51303 and 51803

                In items 51303 and 51803, amount under rule 122, for 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.

123         Meaning of amount under rule 123 in item 51309

         (1)   In item 51309, amount under rule 123, for 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.

124         Meaning of amount under rule 124 in item 51312

                In item 51312, amount under rule 124, for 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.

125         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.

126         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 3BA of the Act.

127         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.

128         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, for 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.

129         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 definition of professional service in subsection 3 (1) of the Act.

Part 3          Services and fees

 

Item

Service

Fee ($)

Attendances

Group A1 — General practitioner attendances to which no other item applies

 

1

Professional 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 in unsociable hours) in an after‑hours period, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period; and

   (b)  the patient’s medical condition requires urgent treatment

114.95

 

2

Professional attendance at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance (other than an attendance in unsociable hours) in an after‑hours period, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period; and

   (b)  the patient’s medical condition requires urgent treatment; and

   (c)  it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(Item is subject to rule 7)

114.95

 

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

15.00

 

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 11

 

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 11

 

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 11

 

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 if 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 11

 

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

32.80

 

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 11

 

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 11

 

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 11

 

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 11

 

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

62.30

 

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 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, 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 11

 

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 11

 

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 11

 

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 if 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 11

 

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

91.70

 

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 11

 

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 11

 

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 11

 

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 if 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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

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 11

 

97

Professional attendance at other than consulting rooms, by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion — each attendance (other than an attendance in unsociable hours) in an after‑hours period, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period; and

   (b)  the patient’s medical condition requires urgent treatment

100.10

 

98

Professional attendance at consulting rooms, by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion — each attendance (other than an attendance in unsociable hours) in an after‑hours period, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period; and

   (b)  the patient’s medical condition requires urgent treatment; and

   (c)  it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(Item is subject to rule 7)

100.10

 

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 or 109 applies

77.25

 

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 subsequent to the first in a single course of treatment where that attendance is at consulting rooms or hospital

38.80

 

106

Professional attendance by a specialist in the practice of his or her specialty of ophthalmology 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 the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses where that attendance is at consulting rooms or hospital

(not being a service to which any of items 104, 109 and 10801 to 10816 applies)

64.15

 

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

113.35

 

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

71.70

 

109

Professional attendance by a specialist in the practice of his or her specialty of ophthalmology 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 a comprehensive eye examination is performed on:

   (a)  a patient younger than 9 years; or

   (b)  a patient younger than 15 years with developmental delay

(not being a service to which any of items 104, 106 and 10801 to 10816 applies)

116.05

 

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

136.30

 

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

68.20

 

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

38.80

 

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

165.40

 

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

100.00

 

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

72.00

 

132

Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 45 minutes duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to him or her by a medical practitioner, if:

   (a)  an assessment is undertaken that covers:

         (i)   a comprehensive history, including psychosocial history and medication review; and

        (ii)   comprehensive multi or detailed single organ system assessment; and

       (iii)   the formulation of differential diagnoses; and

238.30

 

 

   (b)  a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner that involves:

         (i)   an opinion on diagnosis and risk assessment; and

        (ii)   treatment options and decisions; and

       (iii)   medication recommendations; and

   (c)  an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

            (d)        this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

 

 

133

Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 20 minutes duration subsequent to the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

   (a)  a review is undertaken that covers:

         (i)   review of initial presenting problems and results of diagnostic investigations; and

        (ii)   review of responses to treatment and medication plans initiated at time of initial consultation; and

       (iii)   comprehensive multi or detailed single organ system assessment; and

       (iv)   review of original and differential diagnoses; and

   (b)  the modified consultant physician treatment and management plan is provided to the referring practitioner that involves, if appropriate:

         (i)   a revised opinion on the diagnosis and risk assessment; and

        (ii)   treatment options and decisions; and

       (iii)   revised medication recommendations; and

119.30

 

 

   (c)  an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

   (d)  item 132 has applied for an attendance by same consultant physician on the patient in the preceding 12 months; and

   (e)  this item has not applied more than twice in any 12 month period

 

 

Group A28 — Geriatric medicine

 

141

Professional attendance of more than 60 minutes duration at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, if:

   (a)  the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician); and

   (b)  the attendance is initiated by the referring medical practitioner for the provision of a comprehensive assessment and management plan; and

408.80

 

 

   (c)  during the attendance:

         (i)   the medical, physical, psychological and social aspects of the patient’s health are evaluated in detail using appropriately validated assessment tools if indicated (‘assessment’); and

        (ii)   the patient’s various health problems and care needs are identified and prioritised (‘formulation’); and

 

 

 

       (iii)   a detailed management plan is prepared (‘management plan’) setting out:

(A)   the prioritised list of health problems and care needs; and

(B)   short and longer term management goals; and

(C)   recommended actions or intervention strategies to be undertaken by the patient’s general practitioner or other relevant health care providers that are likely to improve or maintain health status, readily available and acceptable to the patient and the patient’s family and any carers; and

 

 

 

       (iv)   the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

        (v)   the management plan is communicated in writing to the referring medical practitioner; and

 

 

 

   (d)  an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

 

 

 

   (e)  an attendance to which this item or item 145 applies has not been provided to the patient by the same practitioner in the preceding 12 months

 

 

143

Professional attendance of more than 30 minutes duration at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under item 141 or 145, if:

   (a)  the review is initiated by the referring medical practitioner practising in general practice; and

   (b)  during the attendance:

         (i)   the patient’s health status is reassessed; and

        (ii)   a management plan prepared under item 141 or 145 is reviewed and revised; and

       (iii)   the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring medical practitioner; and

   (c)  an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies was not provided to the patient on the same day by the same practitioner; and

   (d)  an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

   (e)  an attendance to which this item or item 147 applies has not been provided to the patient in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

255.50

 

145

Professional attendance of more than 60 minutes duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, if:

   (a)  the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician); and

   (b)  the attendance is initiated by the referring medical practitioner for the provision of a comprehensive assessment and management plan; and

   (c)  during the attendance:

         (i)   the medical, physical, psychological and social aspects of the patient’s health are evaluated in detail utilising appropriately validated assessment tools if indicated (‘assessment’); and

        (ii)   the patient’s various health problems and care needs are identified and prioritised (‘formulation’); and

       (iii)   a detailed management plan is prepared (‘management plan’) setting out:

(A)   the prioritised list of health problems and care needs; and

(B)   short and longer term management goals; and

(C)   recommended actions or intervention strategies, to be undertaken by the patient’s general practitioner or other relevant health care providers, that are likely to improve or maintain health status, readily available and acceptable to the patient, the patient’s family and any carers; and

495.65

 

 

       (iv)   the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

        (v)   the management plan is communicated in writing to the referring medical practitioner; and

 

 

 

   (d)  an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

   (e)  an attendance to which this item or item 141 applies has not been provided to the patient by the same practitioner in the preceding 12 months

 

 

147

Professional attendance of more than 30 minutes duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under items 141 or 145, if:

   (a)  the review is initiated by the referring medical practitioner practising in general practice; and

   (b)  during the attendance:

         (i)   the patient’s health status is reassessed; and

        (ii)   a management plan that was prepared under item 141 or 145 is reviewed and revised; and

       (iii)   the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring medical practitioner; and

309.80

 

 

   (c)  an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

   (d)  an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

   (e)  an attendance to which this item or 143 applies has not been provided by the same practitioner in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

 

 

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

196.10

 

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

326.85

 

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

457.45

 

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

588.30

 

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

653.70

 

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

104.10

 

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

109.65

 

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

133.45

 

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 an 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

32.80

 

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 an attendance of less than 20 minutes duration involving components of a service to which item 197 or 199 applies;

Amount under rule 11

 

 

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

 

 

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 an 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

62.30

 

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

91.70

 

 

   (b)  being an 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

 

 

Group A8 — Consultant psychiatrist attendances to which no other item applies

 

291

Professional attendance of more than 45 minutes duration at consulting rooms by a consultant physician in the practice of his or her specialty of psychiatry, if:

   (a)  the attendance follows referral of the patient to the consultant for an assessment or management by a medical practitioner in general practice (including a general practitioner, but not a specialist or consultant physician); and

   (b)  during the attendance, the consultant:

         (i)   uses an outcome tool (if clinically appropriate); and

        (ii)   carries out a mental state examination; and

       (iii)   makes a psychiatric diagnosis; and

   (c)  the consultant decides that it is clinically appropriate for the patient to be managed by the referring medical practitioner without ongoing treatment by the consultant; and

408.80

 

 

   (d)  within 2 weeks after the attendance, the consultant:

         (i)   prepares a written diagnosis of the patient; and

        (ii)   prepares a written management plan for the patient that:

(A)   covers the next 12 months; and

(B)   is appropriate to the patient’s diagnosis; and

(C)   comprehensively evaluates the patient’s biological, psychological and social issues; and

(D)   addresses the patient’s diagnostic psychiatric issues; and

 

 

 

(E)   makes management recommendations addressing the patient’s biological, psychological and social issues; and

       (iii)   gives the referring practitioner a copy of the diagnosis and the management plan; and

 

 

 

       (iv)   if clinically appropriate, explains the diagnosis and management plan, and a gives a copy, to:

(A)   the patient; and

(B)   the patient’s carer (if any), if the patient agrees

(Item is subject to rule 73)

 

 

293

Professional attendance of more than 30 minutes but not more than 45 minutes duration at consulting rooms by a consultant physician in the practice of his or her specialty of psychiatry, if:

   (a)  the patient is being managed by a medical practitioner in accordance with a management plan prepared by the consultant in accordance with item 291; and

   (b)  the attendance follows referral of the patient to the consultant for review of the management plan by the medical practitioner managing the patient; and

   (c)  during the attendance, the consultant:

         (i)   uses an outcome tool (if clinically appropriate); and

        (ii)   carries out a mental state examination; and

       (iii)   makes a psychiatric diagnosis; and

       (iv)   reviews the management plan; and

255.50

 

 

   (d)  within 2 weeks after the attendance, the consultant:

         (i)   prepares a written diagnosis of the patient; and

        (ii)   revises the management plan; and

       (iii)   gives the referring medical practitioner a copy of the diagnosis and the revised management plan; and

 

 

 

       (iv)   if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A)   the patient; and

(B)   the patient’s carer (if any), if the patient agrees; and

   (e)  in the preceding 12 months, a service to which item 291 applies has been provided; and

   (f)  in the preceding 12 months, a service to which this item or item 293 applies has not been provided

(Item is subject to rule 73)

 

 

296

Professional attendance of more than 45 minutes duration by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance at consulting rooms if the patient:

   (a)  is a new patient for this consultant psychiatrist; or

   (b)  has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

not being an attendance on a patient in relation to whom this item, item 297 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 month period

235.05

 

297

Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance at hospital if the patient:

   (a)  is a new patient for this consultant psychiatrist; or

   (b)  has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

not being an attendance on a patient in relation to whom this item, item 296 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 month period (H)

235.05

 

299

Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance at a place other than consulting rooms or a hospital if the patient:

   (a)  is a new patient for this consultant psychiatrist; or

   (b)  has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

not being an attendance on a patient in relation to whom this item, item 296 or 297, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 month period

281.15

 

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, if that attendance and any other attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

39.15

 

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, if that attendance and any other attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

78.10

 

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), if that attendance and any other attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

120.20

 

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, if that attendance and any other attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

165.90

 

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), if that attendance and any other attendance to which any of items 296, 300 to 308 , 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

192.45

 

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 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

19.55

 

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 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

39.15

 

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 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

60.15

 

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 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

83.10

 

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 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

96.30

 

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 296, 300 to 319, 353 to 358 and 361 to 370 applies have not exceeded 160 attendances in a calendar year for the patient

165.90

 

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

39.15

 

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

78.10

 

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

120.20

 

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

165.90

 

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

192.45

 

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 if that attendance is at a place other than consulting rooms or hospital

71.80

 

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 if that attendance is at a place other than consulting rooms or hospital

112.60

 

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 if that attendance is at a place other than consulting rooms or hospital

164.05

 

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 if that attendance is at a place other than consulting rooms or hospital

198.45

 

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 if that attendance is at a place other than consulting rooms or hospital

225.35

 

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

44.55

 

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

59.15

 

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

87.45

 

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

114.45

 

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

158.05

 

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

114.45

 

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 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

51.70

 

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 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

103.30

 

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 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

151.50

 

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 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

209.05

 

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 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

254.65

 

359

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry — a telepsychiatry consultation of more than 30 minutes but not more than 45 minutes duration, if:

   (a)  the patient is being managed by a medical practitioner in accordance with a management plan prepared by the consultant psychiatrist in accordance with item 291; and

   (b)  the attendance follows referral of the patient to the consultant for review of the management plan by the medical practitioner managing the patient; and

293.85

 

 

   (c)  during the attendance, the consultant:

         (i)   uses an outcome tool (if clinically appropriate); and

        (ii)   carries out a mental state examination; and

       (iii)   makes a psychiatric diagnosis; and

       (iv)   reviews the management plan; and

 

 

 

   (d)  within 2 weeks after the attendance, the consultant:

         (i)   prepares a written diagnosis of the patient; and

        (ii)   revises the management plan; and

       (iii)   gives the referring medical practitioner a copy of the diagnosis and the revised management plan; and

       (iv)   if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A)   the patient; and

(B)   the patient’s carer (if any), if the patient agrees; and

   (e)  the patient is located in a regional, rural or remote area (RRMA 3‑7); and

   (f)  in the preceding 12 months, a service to which item 291 applies has been performed; and

   (g)  in the preceding 12 months, a service to which this item or item 293 applies has not been performed

(Item is subject to rule 73)

 

 

361

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 duration, if the patient:

   (a)  either:

         (i)   is a new patient for this consultant psychiatrist; or

        (ii)   has not received a professional attendance from this consultant psychiatrist in the preceding 24 months; and

   (b)  is located in a regional, rural or remote area (RRMA3‑7)

not being an attendance on a patient in relation to whom this item, item 296, 297 or 299, or any of items 300 to 346 and 353 to 370, has applied in the preceding 24 month period

270.30

 

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 a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

39.15

 

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 a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

78.10

 

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 a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

120.20

 

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 a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

165.95

 

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 a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

   (b)  that attendance and any other attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

192.45

 

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

77.25

 

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

38.80

 

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

113.35

 

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

71.70

 

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

17.65

 

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

38.60

 

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

73.25

 

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

107.85

 

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 11

 

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 11

 

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 11

 

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 11

 

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

17.65

 

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

38.60

 

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

73.25

 

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

107.85

 

Subgroup 2 — Urgent attendances — after‑hours period

 

448

Professional attendance at consulting rooms — each attendance (other than an attendance in unsociable hours) in an after‑hours period, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period; and

135.20

 

 

   (b)  the patient’s medical condition requires urgent treatment; and

   (c)  it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(Item is subject to rule 7)

 

 

449

Professional attendance at consulting rooms  — each attendance in unsociable hours if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken period of unsociable hours; and

   (b)  the patient’s medical condition requires urgent treatment; and

   (c)  it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(Item is subject to rule 7)

159.35

 

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

30.85

 

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

52.15

 

 

   (c)  formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and

   (d)  initiation of appropriate treatment interventions

 

 

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

87.70

 

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

124.00

 

 

   (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

192.05

 

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

132.00

 

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

253.60

 

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

415.65

 

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

577.70

 

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

739.95

 

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

821.00

 

Group A11 — Unsociable hours

 

601

Professional attendance at other than consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance in unsociable hours, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken period of unsociable hours; and

   (b)  the patient’s medical condition requires urgent treatment

135.45

 

602

Professional attendance at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance in unsociable hours, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken a period of unsociable hours; and

   (b)  the patient’s medical condition requires urgent treatment; and

   (c)  it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(Item is subject to rule 7)

135.45

 

697

Professional attendance at other than consulting rooms, by a medical practitioner, (other than a general practitioner) on not more than 1 patient on the 1 occasion — each attendance in unsociable hours, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken period of unsociable hours; and

   (b)  the patient’s medical condition requires urgent treatment

118.70

 

698

Professional attendance at consulting rooms, by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion — each attendance in unsociable hours, if:

   (a)  the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken period of unsociable hours; and

   (b)  the patient’s medical condition requires urgent treatment; and

   (c)  it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(Item is subject to rule 7)

118.70

 

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 relation to whom, in the preceding 12 months, a service has been provided under this item or item 702, 704 or 706

(Item is subject to rule 21)

171.15

 

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 relation to whom, in the preceding 12 months, a service has been provided under this item or item 700, 704 or 706

242.05

 

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 relation to whom, in the preceding 12 months, a service has been provided under this item or item 700, 702 or 706

171.15

 

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 relation to whom, in the preceding 12 months, a service has been provided under this item or item 700, 702 or 704

242.05

 

708

Attendance by a medical practitioner (other than a specialist or consultant physician) at consulting rooms or another place (other than a hospital or residential aged care facility) for a child health check of a patient who is younger than 15 and of Aboriginal or Torres Strait Islander descent — not being a child health check of a patient in relation to whom, in the preceding 9 months, a service has been provided under this item

171.15

 

710

Attendance by a medical practitioner (other than a specialist or consultant physician) at consulting rooms or another place (other than a hospital or residential aged care facility) for an adult health check of a patient who is of Aboriginal or Torres Strait Islander descent and at least 15 years old and less than 55 years old — not being an adult health check of a patient in relation to whom, in the preceding 18 months, a service has been provided under this item

204.00

 

712

Attendance by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) at a residential aged care facility or at consulting rooms for a comprehensive medical assessment (CMA) of a permanent resident of a residential aged care facility — not being a CMA of a resident in relation to whom, in the preceding 12 months, a service has been provided under this item

191.80

 

714

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 a humanitarian visa holder — not being a health assessment of a patient in relation to whom a service has been provided under this item or item 700, 702, 712 or 716

(Item is subject to rule 20)

204.00

 

716

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 a humanitarian visa holder — not being a health assessment of a patient in relation to whom a service has been provided under this item or item 700, 702, 712 or 714

(Item is subject to rule 20)

Amount under rule 11

 

717

Attendance by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) at a place other than a hospital to undertake a health check for a patient between the age of 45 and 49 (inclusive) at risk of developing a chronic disease

(Item is subject to rule 27)

102.20

 

 

718

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 with an intellectual disability — not being a health assessment of a patient in relation to whom, in the preceding 12 months, a service has been provided under this item or item 719

204.00

 

719

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 residential aged care facility for a health assessment of a patient with an intellectual disability — not being a health assessment for a patient in relation to whom, in the preceding 12 months, a service has been provided under this item or item 718

226.95

 

Group A15 — GP management plans, team care arrangements and multidisciplinary care plans and case conferences

 

Subgroup 1 — GP management plans, team care arrangements and multidisciplinary care plans

 

721

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), for preparation of a GP management plan for a patient (not being a service associated with a service to which any of items 734 to 779 apply)

(Item is subject to rule 29)

127.70

 

723

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to co‑ordinate the development of team care arrangements for a patient (not being a service associated with a service to which any of items 734 to 779 apply)

(Item is subject to rule 29)

101.15

 

725

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to review:

   (a)  a GP management plan prepared by that medical practitioner (or an associated medical practitioner) to which item 721 applies; or

   (b)  a multidisciplinary community care plan to which former item 720 applied, or a multidisciplinary discharge care plan to which former item 722 applied, prepared by that medical practitioner (or an associated medical practitioner)

(not being a service associated with a service to which any of items 734 to 779 apply)

(Item is subject to rule 29)

63.85

 

727

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to co‑ordinate a review of:

   (a)  team care arrangements co‑ordinated by that medical practitioner (or an associated medical practitioner) to which item 723 applies; or

   (b)  a multidisciplinary community care plan to which former item 720 applied, or a multidisciplinary discharge care plan to which former item 722 applied, prepared by that medical practitioner (or an associated medical practitioner)

(not being a service associated with a service to which any of items 734 to 779 apply)

(Item is subject to rule 29)

63.85

 

729

Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (not being a service associated with a service to which any of items 734 to 779 apply)

(Item is subject to rule 29)

62.30

 

731

Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to:

   (a)  a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or

   (b)  a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital or an approved day‑hospital facility, or to a review of such a plan prepared by another provider

(not being a service associated with a service to which items 734 to 779 apply)

(Item is subject to rule 29)

62.30

 

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, if the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 731 applies)

85.60

 

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, if the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which item 731 applies)

128.40

 

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, if the conference time is at least 45 minutes (not being a service associated with a service to which item 731 applies)

171.15

 

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, if the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 721 to 731 apply)

85.60

 

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, if the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 721 to 731 apply)

128.40

 

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, if the conference time is at least 45 minutes (not being a service associated with a service to which items 721 to 731 apply)

171.15

 

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, if the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 721 to 731 apply) — applicable not more than once for each hospital admission

85.60

 

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, if the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 721 to 731 apply) — applicable not more than once for each hospital admission

128.40

 

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, if the conference time is at least 45 minutes (not being a service associated with a service to which items 721 to 731 apply) — applicable not more than once for each hospital admission

171.15

 

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), if the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 721 to 731 apply)

61.10

 

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), if the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 721 to 731 apply)

97.80

 

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), if the conference time is at least 45 minutes (not being a service associated with a service to which items 721 to 731 apply)

134.45

 

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), if the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 721 to 731 apply) — payable not more than once for each hospital admission

61.10

 

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), if the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 721 to 731 apply) — payable not more than once for each hospital admission

97.80

 

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), if the conference time is at least 45 minutes, (not being a service associated with a service to which items 721 to 731 apply) — payable not more than once for each hospital admission

134.45

 

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), if the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 731 applies)

61.10

 

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), if the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which item 731 applies)

97.80

 

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), if the conference time is at least 45 minutes, (not being a service associated with a service to which item 731 applies)

134.45

 

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

125.60

 

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

188.45

 

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

251.15

 

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

90.25

 

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

143.90

 

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

197.55

 

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

125.60

 

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

188.45

 

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

251.15

 

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

90.25

 

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

143.90

 

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

197.55

 

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

125.60

 

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

188.45

 

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

251.15

 

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

125.60

 

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

188.45

 

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

251.15

 

871

Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to lead and coordinate a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least 3 other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

72.55

 

872

Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least 4 medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

33.75

 

880

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of geriatric or rehabilitation medicine, as a member of a case conference team, to co‑ordinate a case conference of at least 10 minutes but less than 30 minutes — for any particular patient, 1 attendance only in a 7 day period (not being an attendance on the same day as an attendance for which item 832, 834, 835, 837 or 838 was applicable in relation to the patient) (H)

(Item is subject to rule 46)

43.90

 

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, in which 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

137.05

 

 

   (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 if there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR

 

 

903

Participation by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) in a residential medication management review (RMMR) for a patient who is a permanent resident of a residential aged care facility — not being an RMMR for a resident in relation to whom, in the preceding 12 months, this item has applied, unless there has been a significant change in the resident’s medical condition or medication management plan requiring a new RMMR

93.85

 

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

 

2497

Professional attendance at consulting rooms by a general practitioner:

   (a)  involving taking a short patient history and, if required, limited examination and management; and

   (b)  at which a cervical smear is taken from a woman between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years

15.00

 

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 an attendance of less than 20 minutes duration involving components of a service to which item 36, 37, 38, 40, 43, 44, 47, 48, 50 or 51 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

32.80

 

2503

Professional attendance at a place other than consulting rooms by a general practitioner:

   (a)  involving taking a short patient history and, if required, limited examination and management; and

   (b)  at which a cervical smear is taken from a woman between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years

Amount under rule 49

 

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 an attendance of less than 40 minutes duration involving components of a service to which item 44, 47, 48, 50 or 51 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

62.30

 

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 an attendance of less than 40 minutes duration involving components of a service to which item 44, 47, 48, 50 or 51 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 49

 

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 an 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

91.70

 

2509

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 an 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 49

 

Subgroup 2 — Completion of a 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 an 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 a cycle of care of a patient with established diabetes mellitus

32.80

 

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 an 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 a cycle of care of a patient with established diabetes mellitus

Amount under rule 49

 

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 an attendance of less than 40 minutes duration involving components of a service to which item 2525 applies;

that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

62.30

 

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 an attendance of less than 40 minutes duration involving components of a service to which item 2526 applies;

that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under rule 49

 

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 an attendance of at least 40 minutes duration for implementation of a management plan;

that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

91.70

 

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 an attendance of at least 40 minutes duration for implementation of a management plan;

that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under rule 49

 

Subgroup 3 — Completion of the Asthma Cycle of Care

 

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 an 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 Cycle of Care

32.80

 

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 an 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 Cycle of Care

Amount under rule 49

 

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 an 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 Cycle of Care

62.30

 

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 an 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 Cycle of Care

Amount under rule 49

 

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 an attendance of at least 40 minutes duration for implementation of a management plan;

that completes the minimum requirements of the Asthma Cycle of Care

91.70

 

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 an attendance of at least 40 minutes duration for implementation of a management plan;

that completes the minimum requirements of the Asthma Cycle of Care

Amount under rule 49

 

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

 

2598

Professional attendance at consulting rooms of less than 5 minutes duration by a medical practitioner who practices 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 years (inclusive) who has not had a cervical smear in the last 4 years

11.00

 

2600

Professional attendance at consulting rooms of more than 5, 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 11

 

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 11

 

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 11

 

Subgroup 2 — Completion of a 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 a 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 a 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 a 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 a cycle of care of a patient with established diabetes mellitus

Amount under rule 11

 

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 a cycle of care of a patient with established diabetes mellitus

Amount under rule 11

 

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 a cycle of care of a patient with established diabetes mellitus

Amount under rule 11

 

Subgroup 3 — Completion of the Asthma Cycle of Care

 

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 Cycle of Care

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 Cycle of Care

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 Cycle of Care

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 Cycle of Care

Amount under rule 11

 

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 Cycle of Care

Amount under rule 11

 

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 Cycle of Care

Amount under rule 11

 

Group A20 — Mental health care

 

Subgroup 1 — GP Mental Health Care Plans

 

2710

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) for the preparation of a GP Mental Health Care Plan for a patient

153.30

 

2712

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to review a GP Mental Health Care Plan prepared by that medical practitioner (or an associated medical practitioner) or to review a Psychiatrist Assessment and Management Plan

102.20

 

2713

Professional attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) on a patient in relation to a mental disorder and lasting at least 20 minutes, involving taking relevant history and identifying the presenting problem or problems (to the extent not previously recorded), providing treatment, advice and/or referral for other services or treatments and documenting the outcomes of the consultation

67.45

 

Subgroup 2 — 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 for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

82.10

 

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 for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

Amount under rule 49

 

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 for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

117.55

 

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 for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

Amount under rule 49

 

Group A24 — Palliative and pain medicine

 

Subgroup 1 — Pain medicine attendances

 

2801

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment

(Item is subject to rule 53)

136.30

 

2806

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a medical practitioner — each attendance (not being a service to which item 2814 applies) subsequent to the first in a single course of treatment

(Item is subject to rule 53)

68.20

 

2814

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a medical practitioner — each minor attendance subsequent to the first attendance in a single course of treatment

(Item is subject to rule 53)

38.80

 

2824

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment

(Item is subject to rule 53)

165.40

 

2832

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a medical practitioner — each attendance (not being a service to which item 2840 applies) subsequent to the first in a single course of treatment

(Item is subject to rule 53)

100.00

 

2840

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a medical practitioner — each minor attendance subsequent to the first attendance in a single course of treatment

(Item is subject to rule 53)

72.00

 

Subgroup 2 — Pain medicine case conferences

 

2946

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, 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

(Item is subject to rules 53 and 73)

125.60

 

2949

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, 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

(Item is subject to rules 53 and 73)

188.45

 

2954

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, 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

(Item is subject to rules 53 and 73)

251.15

 

2958

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a case conference team, to participate in a community case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

90.25

 

2972

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a case conference team, to participate in a community case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

143.90

 

2974

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a case conference team, to participate in a community case conference (other than to organise and co‑ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

(Item is subject to rules 53 and 73)

197.55

 

2978

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, 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

(Item is subject to rules 53 and 73)

125.60

 

2984

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, 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

(Item is subject to rules 53 and 73)

188.45

 

2988

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, 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

(Item is subject to rules 53 and 73)

251.15

 

2992

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

90.25

 

2996

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

143.90

 

3000

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and co‑ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

(Item is subject to rules 53 and 73)

197.55

 

Subgroup 3 — Palliative medicine attendances

 

3005

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment

(Item is subject to rule 53)

136.30

 

3010

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a medical practitioner — each attendance (not being a service to which item 3014 applies) subsequent to the first in a single course of treatment

(Item is subject to rule 53)

68.20

 

3014

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a medical practitioner — each minor attendance subsequent to the first attendance in a single course of treatment

(Item is subject to rule 53)

38.80

 

3018

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment

(Item is subject to rule 53)

165.40

 

3023

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a medical practitioner — each attendance (not being a service to which item 3028 applies) subsequent to the first in a single course of treatment

(Item is subject to rule 53)

100.00

 

3028

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a medical practitioner — each minor attendance subsequent to the first attendance in a single course of treatment

(Item is subject to rule 53)

72.00

 

Subgroup 4 — Palliative medicine case conferences

 

3032

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, 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

(Item is subject to rules 53 and 73)

125.60

 

3040

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, 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

(Item is subject to rules 53 and 73)

188.45

 

3044

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, 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

(Item is subject to rules 53 and 73)

251.15

 

3051

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a community case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

90.25

 

3055

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a community case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

143.90

 

3062

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a community case conference (other than to organise and co‑ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

(Item is subject to rules 79 and 73)

197.55

 

3069

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, 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

(Item is subject to rules 53 and 73)

125.60

 

3074

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, 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

(Item is subject to rules 53 and 73)

188.45

 

3078

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, 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

(Item is subject to rules 53 and 73)

251.15

 

3083

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

90.25

 

3088

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and 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

(Item is subject to rules 53 and 73)

143.90

 

3093

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and co‑ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

(Item is subject to rules 53 and 73)

197.55

 

Group A27 — Pregnancy support counselling

4001

Professional attendance of at least 20 minutes duration at consulting rooms by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is registered with Medicare Australia as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service to which this item or item 81000*, 81005* or 81010* applies in relation to that pregnancy

Note   Asterisked items relate to a health service specified in the Health Insurance (Allied Health and Dental Services) Determination 2007.

67.80

Group A22 — General practitioner after‑hours attendances to which no other item applies

5000

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

25.65

5003

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 11

5007

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 11

5010

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 11

5020

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 5040 or 5060 applies — each attendance

43.45

5023

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 5043 or 5063 applies — an attendance on 1 or more patients on 1 occasion — each patient

Amount under rule 11

5026

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 5046 or 5064 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient

Amount under rule 11

5028

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 5049 or 5067 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient

Amount under rule 11

5040

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 5060 applies — each attendance

72.90

5043

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 5063 applies — an attendance on 1 or more patients on 1 occasion — each patient

Amount under rule 11

5046

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 5064 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient

Amount under rule 11

5049

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 5067 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient

Amount under rule 11

5060

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

102.35

5063

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 11

5064

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 11

5067

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 if 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 11

Group A23 — Other non‑referred after‑hours attendances to which no other item applies

5200

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

21.00

5203

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

31.00

5207

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

48.00

5208

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

71.00

5220

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 11

5223

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 11

5227

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 11

5228

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 11

5240

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 11

5243

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 11

5247

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 11

5248

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 11

5260

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 if 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 11

5263

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 if 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 11

5265

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 if 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 11

5267

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 if 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 11

Group A25 — Outer metropolitan specialist trainee attendances

5906

Professional attendance at consulting rooms of not more than 5 minutes duration by an outer metropolitan specialist trainee

17.65

5908

Professional attendance at consulting rooms of more than 5 minutes duration but not more than 20 minutes duration by an outer metropolitan specialist trainee

38.60

5910

Professional attendance at consulting rooms of more than 20 minutes duration but not more than 40 minutes duration by an outer metropolitan specialist trainee

73.25

5912

Professional attendance at consulting rooms of more than 40 minutes duration by an outer metropolitan specialist trainee

107.85

Group A26 — Neurosurgery attendances to which no other item applies

6007

Professional attendance by a specialist in the practice of neurosurgery 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 consulting rooms or hospital

117.05

6009

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her — a minor attendance subsequent to the first in a single course of treatment at consulting rooms or hospital

38.80

6011

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her — an attendance subsequent to the first in a single course of treatment, involving an extensive and comprehensive examination, arranging any necessary investigations in relation to 1 or more complex problems and of more than 15 minutes duration but not more than 30 minutes duration at consulting rooms or hospital

77.25

6013

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her — an attendance subsequent to the first in a single course of treatment, involving a detailed and comprehensive examination, arranging any necessary investigations in relation to 1 or more complex problems and of more than 30 minutes duration but not more than 45 minutes duration at consulting rooms or hospital

107.05

6015

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her — an attendance subsequent to the first in a single course of treatment, involving an exhaustive and comprehensive examination, arranging any necessary investigations in relation to 1 or more complex problems and of more than 45 minutes duration at consulting rooms or hospital

136.30

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

109.85

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

109.85

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

109.85

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

109.85

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)

109.85

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

109.85

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

109.85

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

109.85

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

109.85

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

109.85

Group A10 — Optometric services provided by a participating optometrist

10900

Professional attendance of more than 15 minutes duration, being the first in a course of attention

(Item is subject to rule 120)

64.15

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

64.15

10907

Professional attendance of more than 15 minutes duration, being the first in a course of attention, if 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. The appropriate fee for the purpose of paragraph 23A (2) (c) of the Health Insurance Act 1973 is $62.75

32.10

 

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

64.15

 

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

64.15

 

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

64.15

 

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

64.15

 

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 10931, 10932, 10933, 10940, 10941, 10942 or 10943 applies)

32.10

 

10918

Professional attendance, being the second or subsequent in a course of attention and being unrelated to the prescription and fitting of contact lenses (not being a service associated with a service to which item 10940 or 10941 applies)

32.10

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye

(Item is subject to rule 73)

159.05

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye

(Item is subject to rule 73)

159.05

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — patients with astigmatism of 3.0 dioptres or greater in 1 eye

(Item is subject to rule 73)

159.05

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — 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

(Item is subject to rule 73)

200.75

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

(Item is subject to rule 73)

159.05

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — 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

(Item is subject to rule 73)

159.05

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — 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

(Item is subject to rule 73)

200.75

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — patients who, by reason of physical deformity, are unable to wear spectacles

(Item is subject to rule 73)

159.05

 

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 for which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — 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

(Item is subject to rule 73)

200.75

 

10930

All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses if 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

159.05

 

10931

A service to which an item in Group A10 applies (other than this item or item 10916, 10932, 10933, 10940 or 10941), if the service:

   (a)  is provided:

         (i)   during a home visit to a person; or

        (ii)   in a residential aged care facility; or

       (iii)   in an institution; and

   (b)  is provided to a single patient at a single location on a single occasion; and

   (c)  is:

         (i)   bulk‑billed for the fees for this item and another item in this table applying to the service; or

        (ii)   not bulk‑billed for the fees for this item and another item in this table applying to the service

(Item is subject to rule 75)

22.35

 

10932

A service to which an item in Group A10 applies (other than this item or item 10916, 10931, 10933, 10940 or 10941), if the service:

   (a)  is provided:

         (i)   during a home visit to a person; or

        (ii)   in a residential aged care facility; or

       (iii)   in an institution; and

   (b)  is provided to each of 2 patients at a single location on a single occasion; and

   (c)  is:

         (i)   bulk‑billed for the fees for this item and another item in this table applying to the service; or

        (ii)   not bulk‑billed for the fees for this item and another item in this table applying to the service

(Item is subject to rule 75)

11.15

 

10933

A service to which an item in Group A10 applies (other than this item or item 10916, 10931, 10932, 10940 or 10941), if the service:

   (a)  is provided:

         (i)   during a home visit to a person; or

        (ii)   in a residential aged care facility; or

       (iii)   in an institution; and

   (b)  is provided to each of 3 patients at a single location on a single occasion; and

   (c)  is:

         (i)   bulk‑billed for the fees for this item and another item in this table applying to the service; or

        (ii)   not bulk‑billed for the fees for this item and another item in this table applying to the service

(Item is subject to rule 75)

7.45

 

10940

Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:

   (a)  is not a service involving multifocal multichannel objective perimetry; and

   (b)  is performed by an optometrist;

not being a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies

(Item is subject to rule 120)

61.20

 

10941

Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:

   (a)  is not a service involving multifocal multichannel objective perimetry; and

   (b)  is performed by an optometrist;

not being a service associated with a service to which item 10916, 10918 10931, 10932 or 10933 applies

(Item is subject to rule 74)

36.90

 

10942

Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N.12 or worse in the better eye or a horizontal visual field of less than 120 degrees and within 10 degrees above and below the horizontal midline, involving 1 or more of the following:

   (a)  spectacle correction;

   (b)  determination of contrast sensitivity;

   (c)  determination of glare sensitivity;

   (d)  prescription of magnification aids;

not being a service associated with a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

(Item is subject to rule 73)

32.10

 

10943

Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant binocular or accommodative dysfunction, in a patient aged 3 to 14 years, including assessment of 1 or more of the following:

   (a)  accommodation;

   (b)  ocular motility;

   (c)  vergences;

   (d)  fusional reserves;

32.10

 

 

   (e)  cycloplegic refraction;

not being a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

(Item is subject to rules 73 and 76)

 

 

Miscellaneous services

 

Group 5 — Services provided by a registered Aboriginal health worker on behalf of a medical practitioner

 

10988

Immunisation provided to a person by a registered Aboriginal health worker if:

   (a)  the immunisation is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

(Item is subject to rule 65)

10.85

 

10989

Treatment of a person’s wound (other than normal aftercare) provided by a registered Aboriginal health worker if:

   (a)  the treatment is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

(Item is subject to rule 66)

10.85

 

Group 1 — Management of bulk‑billed services

 

10990

A medical service to which an item in this table (other than this item or item 10991 or 10992) applies if:

   (a)  the service is an unreferred service; and

   (b)  the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

   (c)  the person is not an admitted patient of a hospital; and

6.35

 

 

   (d)  the service is bulk‑billed in respect of the fees for:

         (i)   this item; and

        (ii)   the other item in this table applying to the service

 

 

10991

A medical service to which an item in this table (other than this item or item 10990 or 10992) applies if:

   (a)  the service is an unreferred service; and

   (b)  the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

9.60

 

 

   (c)  the person is not an admitted patient of a hospital; and

 

 

 

   (d)  the service is bulk‑billed in respect of the fees for:

         (i)   this item; and

        (ii)   the other item in this table applying to the service; and

 

 

 

   (e)  the service is provided at, or from, a practice location in an eligible area

 

 

10992

A medical service to which item 1, 97, 601, 697, 5003, 5007, 5010, 5023, 5026, 5028, 5043, 5046, 5049, 5063, 5064, 5067, 5220, 5223, 5227, 5228, 5240, 5243, 5247, 5248, 5260, 5263, 5265 or 5267 applies if:

   (a)  the service is an unreferred service; and

   (b)  the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

   (c)  the person is not an admitted patient of a hospital; and

   (d)  the service is not provided in consulting rooms; and

   (e)  the service is provided in an eligible area; and

   (f)  the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an eligible area; and

   (g)  the service is bulk‑billed in respect of the fees for:

         (i)   this item; and

        (ii)   the other item in this table applying to the service

9.60

 

Group 2 — Services provided by a practice nurse on behalf of a medical practitioner

 

10993

Immunisation provided to a person by a practice nurse if:

   (a)  the immunisation is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

10.85

 

10994

Service provided by a practice nurse, being the taking of a cervical smear and preventive health check on a person, if:

   (a)  the service is provided on behalf of, and under the supervision of a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

21.70

 

10995

Service provided by a practice nurse, being the taking of a cervical smear and preventive health check on a woman between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years, if:

   (a)  the service is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

21.70

 

10996

Treatment of a person’s wound (other than normal aftercare) provided by a practice nurse if:

   (a)  the treatment is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

10.85

 

10997

Service provided by a practice nurse or registered Aboriginal health worker to a person with a chronic disease, if:

   (a)  the service is provided on behalf of and under the supervision of a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital; and

   (c)  the person has a GP management plan, team care arrangements or multidisciplinary care plan in place and the service is consistent with the plan or arrangements;

to a maximum of 5 services per patient in a calendar year

10.85

 

10998

Service provided by a practice nurse, being the taking of a cervical smear from a person, if:

   (a)  the service is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

10.85

 

10999

Service provided by a practice nurse, being the taking of a cervical smear from a woman between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years, if:

   (a)  the service is provided on behalf of, and under the supervision of, a medical practitioner; and

   (b)  the person is not an admitted patient of a hospital

10.85

 

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.)

111.20

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

294.20

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

294.20

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

294.20

11006

Electroencephalography, temporosphenoidal, not being a service involving quantitative topographic mapping using neurometrics or similar devices

150.85

11009

Electrocorticography

205.65

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)

101.10

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)

135.35

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)

202.25

11021

Neuromuscular electrodiagnosis — repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis or both of these examinations

135.35

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

102.85

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

152.50

Subgroup 2 — Ophthalmology

11200

Provocative test or tests for glaucoma, including water drinking

36.85

11203

Tonography — in the investigation or management of glaucoma, of 1 or both eyes — using an electrical tonography machine producing a directly recorded tracing

62.25

11204

Electroretinography of 1 or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards

97.75

11205

Electrooculography of 1 or both eyes performed according to current professional guidelines or standards

97.75

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

97.75

11211

Dark adaptometry of 1 or both eyes with a quantitative estimation of threshold in log lumens at 45 minutes of dark adaptations

97.75

11212

Optic fundi, examination of following intravenous dye injection

63.30

11215

Retinal photography, multiple exposures, of 1 eye with intravenous dye injection

111.10

11218

Retinal photography, multiple exposures of both eyes with intravenous dye injection

137.20

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, if 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

61.20

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, if 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:

61.20

 

   (a)  established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;

 

 

   (b)  established neurological disease which may be progressive and if 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, if 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, if 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

36.90

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, if 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 (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;

   (b)  established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;

36.90

 

   (c)  monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;

each additional examination

 

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

110.85

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

73.55

11240

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, 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

73.55

11241

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, 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

93.60

11242

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, 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

72.35

11243

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, 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

72.35

Subgroup 3 — Otolaryngology

11300

Brain stem evoked response audiometry (Anaes.)

173.80

11303

Electrocochleography, extratympanic method, 1 or both ears

173.80

11304

Electrocochleography, transtympanic membrane insertion technique, 1 or both ears

286.20

11306

Non‑determinate audiometry

19.85

11309

Audiogram, air conduction

23.75

11312

Audiogram, air and bone conduction or air conduction and speech discrimination

33.55

11315

Audiogram, air and bone conduction and speech

44.45

11318

Audiogram, air and bone conduction and speech, with other cochlear tests

54.85

11321

Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff’s test)

104.20

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, if 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

29.65

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, if the patient is referred by a medical practitioner — being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies

17.85

11330

Impedance audiogram if the patient is not referred by a medical practitioner — 1 examination in any 4 week period

7.15

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;

52.85

 

   (h)  exchange transfusion;

if:

    (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

40.25

11336

Simultaneous bithermal caloric test of labyrinths

40.25

11339

Electronystagmography

40.25

Subgroup 4 — Respiratory

11500

Bronchospirometry, including gas analysis

150.85

11503

Measurement of:

   (a)  the mechanical or gas exchange function of the respiratory system; or

   (b)  respiratory muscle function; or

   (c)  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 supervised by a specialist or consultant physician or carried out in the respiratory laboratory of a hospital) (not being a service associated with a service to which item 22018 applies) — each occasion at which 1 or more such tests are carried out

125.20

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

18.50

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

32.20

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

55.75

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)

62.55

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 each limb using intermittent limb compression or Valsalva manoeuvres , or both, 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 2 examinations in a 12 month period

52.10

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

68.40

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 or obstruction, or both) 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

68.40

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

57.55

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

57.55

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

101.50

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

68.40

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

68.55

11627

Pulmonary artery pressure monitoring during open heart surgery, in a person under 12 years of age

206.50

Subgroup 6 — Cardiovascular

11700

Twelve‑lead electrocardiography, tracing and report

28.20

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

14.05

11702

Twelve‑lead electrocardiography, tracing only

14.05

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

115.50

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

151.25

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

46.85

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

25.50

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

137.35

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

62.95

11715

Blood dye — dilution indicator test

109.10

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

31.40

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

62.95

11722

Implanted ECG loop recording for the investigation of recurrent unexplained syncope if:

   (a)  a diagnosis has not been achieved through all other available cardiac investigations; and

   (b)  a neurogenic cause is not suspected; and

   (c)  the patient to whom the service is provided does not have a structural heart defect associated with a high risk of sudden cardiac death;

including reprogramming when required, retrieval of stored data, analysis, interpretation and report, not being a service to which item 38285 applies

31.40

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

152.50

11727

Implanted defibrillator testing involving electrocardiography, assessment of pacing and sensing thresholds for pacing and defibrillation electrodes, download and interpretation of stored events and electrograms, including programming when required, not being a service associated with a service to which item 11700, 11718 or 11721 applies

85.65

Subgroup 7 — Gastroenterology and colorectal

11800

Oesophageal motility test, manometric

157.60

11810

Clinical assessment of gastro‑oesophageal reflux disease involving 24‑hour pH monitoring, including analysis, interpretation and report and including any associated consultation

157.60

11820

Capsule endoscopy to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

   (a)  the service is performed by a specialist or consultant physician with endoscopic training that is recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

   (b)  the patient to whom the service is provided:

         (i)   is aged 10 years or over; and

        (ii)   has recurrent or persistent bleeding; and

       (iii)   is anaemic or has active bleeding; and

1 841.55

 

   (c)  an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the bleeding; and

   (d)  the service is performed within 6 months after the upper gastrointestinal endoscopy and colonoscopy;

   (e)  the service is not associated with double balloon enteroscopy

 

11830

Diagnosis of abnormalities of the pelvic floor involving anal manometry or measurement of anorectal sensation or measurement of the rectosphincteric reflex

168.65

11833

Diagnosis of abnormalities of the pelvic floor and sphincter muscles involving electromyography or measurement of pudendal and spinal nerve motor latency

225.55

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

24.90

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

100.35

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

100.35

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

149.05

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.)

149.05

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.)

149.05

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.)

386.80

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.)

386.80

11921

Bladder washout test for localisation of urinary infection — not including bacterial counts for organisms in specimens

67.70

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

35.15

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

53.15

12012

Epicutaneous patch testing in the investigation of allergic dermatitis using less than the number of allergens included in a standard patch test battery

18.75

12015

Epicutaneous patch testing in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery

56.40

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

72.60

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

106.45

Subgroup 10 — Other diagnostic procedures and investigations

12200

Collection of specimen of sweat by iontophoresis

33.60

12201

Administration, by a specialist or consultant physician in the practice of his or her specialty, of thyrotropin alfa‑rch (recombinant human thyroid‑stimulating hormone), and arranging services to which both items 61426 and 66650 apply, for the detection of recurrent well‑differentiated thyroid cancer in a patient if:

   (a)  the patient has had a total thyroidectomy and 1 ablative dose of radioactive iodine; and

   (b)  the patient is maintained on thyroid hormone therapy; and

   (c)  the patient is at risk of recurrence; and

2 161.00

 

   (d)  on at least 1 previous whole body scan or serum thyroglobulin test when withdrawn from thyroid hormone therapy, the patient did not have evidence of well‑differentiated thyroid cancer; and

   (e)  either:

         (i)   withdrawal from thyroid hormone therapy resulted in severe psychiatric disturbances when hypothyroid; or

        (ii)   withdrawal is medically contra‑indicated because the patient has:

(A)   unstable coronary artery disease; or

(B)   hypopituitarism; or

(C)   a high risk of relapse or exacerbation of a previous severe psychiatric illness

— applicable once only in a 12 month period

 

12203

Overnight investigation for sleep apnoea for a period of at least 8 hours duration, for a patient aged 18 years or more, if:

   (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

531.05

 

   (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, if:

   (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

531.05

 

   (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

 

 

   (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;

if 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 if 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, if:

   (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

633.80

 

   (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, if:

   (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, m