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Determinations/Health as amended, taking into account amendments up to Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1)
This Determination enables children to seek allied health services under the Better Start for Children with Disability initiative.
Administered by: Health
Registered 02 Apr 2012
Start Date 01 Mar 2012
End Date 30 Jun 2012
Date of repeal 01 Jan 2014
Repealed by Health Insurance (Allied Health Services) Determination 2014
Table of contents.

Health Insurance (Allied Health Services) Determination 2011

as amended

made under subsection 3C (1) of the

This compilation was prepared on 1 March 2012
taking into account amendments up to Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1)

Prepared by the Department of Health and Ageing, Canberra

 

Contents

1                             Name of Determination [see Note 1]                                                    3

2                             Commencement                                                                                  3

3                             Revocation                                                                                         3

4                             Interpretation                                                                                      3

5                             Treatment of allied health services                                                       8

6                             Limitation on certain individual items                                                    8

6A                           Limitation on certain group items                                                         9

7                             Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services                                              9

8                             Referrals by psychiatrists and paediatricians for pervasive developmental disorder services  9

8A                           Referrals by specialists, consultant physicians and general practitioners for disability services                                                                                                        10

9                             Effect of election to claim private health insurance for an allied health service           11

9A                           Pervasive developmental disorder and disability services course of assessment – reporting requirements                                                                                     11

10                            Focussed Psychological Strategies health services                            11

11                            Reconsideration of Decision                                                              13

Schedule 1              Qualification requirements for allied health professionals               15

Schedule 2              Allied health services                                                                       19

Part 1                      Services and fees — general                                                             19

Part 2                      Services and fees — psychological therapy and focussed psychological strategies  29

Part 3                      Services and fees — pregnancy support counselling                          35

Part 4                      Services and fees — group services                                                  37

Division 4.1             Diabetes education services                                                              37

Division 4.2             Exercise physiology services                                                            38

Division 4.3             Dietetics services                                                                              39

Part 5                      Services and fees — pervasive developmental disorder or disability services            41

Part 6                      Services and fees — Aboriginal and Torres Strait Islander services      46

 

Notes                                                                                                                                                                        53

 


  

  

1              Name of Determination [see Note 1]

                This Determination is the Health Insurance (Allied Health Services) Determination 2011.

2              Commencement

                This Determination commences on 1 July 2011.

3              Revocation

                The Health Insurance (Allied Health Services) Determination 2010 is revoked.

4              Interpretation

         (1)   In this Determination:

Act means the Health Insurance Act 1973.

allied health professional, for the provision of an allied health service, means a person:

                (a)    who meets the qualification requirements set out in Schedule 1 for the provision of the service; and

               (b)    whose name is entered in the register, kept by the Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind.

Note: Allied health professionals in relation to the provision of a focussed psychological strategies health service are subject to the requirements of section 10.

    allied health service means:

(a)        a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975; or

(b)       a health service that is an optometry treatment service;

that is specified in an item in Schedule 2.

course of assessment means:

(a)    for pervasive developmental disorder services – up to 4 services to which any of items 82000, 82005, 82010 or 82030 applies provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:

(i)         an eligible audiologist;

(ii)        an eligible occupational therapist;

(iii)       an eligible optometrist;

(iv)       an eligible orthoptist;

(v)        an eligible physiotherapist;

(vi)       an eligible psychologist; or

(vii)      an eligible speech pathologist; or

 

(b)    for disability services – up to 4 services to which any of items 82000, 82005, 82010 or 82030 applies provided, on referral by a specialist or consultant physician practising in the practice of his or her field of specialty or a general practitioner, by any of the following persons:

(i)         an eligible audiologist;

(ii)        an eligible occupational therapist;

(iii)       an eligible optometrist;

(iv)       an eligible orthoptist;

(v)        an eligible physiotherapist;

(vi)       an eligible psychologist; or

(vii)      an eligible speech pathologist.

course of treatment means:

                (a)    for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:

                          (i)    an eligible clinical psychologist;

                         (ii)    an eligible psychologist;

                        (iii)    an eligible occupational therapist;

                        (iv)    an eligible social worker; or

               (b)    for pervasive developmental disorder services — up to 10 treatment services to which any of items 82015, 82020, 82025 and 82035 applies provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:

                        (i)      an eligible audiologist;

                             (ii)      an eligible occupational therapist;

                        (iii)     an eligible optometrist;

                        (iv)     an eligible orthoptist;

                        (v)     an eligible physiotherapist;

(vi)           an eligible psychologist;

(vii)         an eligible speech pathologist; or

                (c)    for disability services — up to 10 treatment services to which any of items 82015, 82020, 82025 and 82035 applies provided, on referral by a specialist or consultant physician specialising in the practice of his or her field of specialty, or a general practitioner, by any of the following persons:

                        (i)        an eligible audiologist;

                             (ii)        an eligible occupational therapist;

                        (iii)       an eligible optometrist;

                        (iv)       an eligible orthoptist;

                         (v)       an eligible physiotherapist;

(vi)           an eligible psychologist;

(vii)         an eligible speech pathologist.

CPD year means the period of time in which focussed psychological strategies continuing professional development must be completed being:

(a) from the date of commencement of the Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 1) to 30 June 2011; and

(b) after 30 June 2011, 1 July to 30 June annually.

disability treatment and management plan for a child, means a plan for the treatment and management of the child’s eligible disability to which item 137 or 139 of the general medical services table applies. 

eligible Aboriginal health worker means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service.

eligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.

eligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.

eligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.

eligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.

eligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.

eligible disability means any of the following:

(a)                sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;

(b)                hearing impairment that results in:

(i)         a hearing loss of 40 decibels or greater in the better ear, across four frequencies; or

(ii)        permanent conductive hearing loss and auditory neuropathy;

(c)                cerebral palsy;

(d)               Down syndrome; 

(e)                Fragile X syndrome.

eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.

eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.

eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.

eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:

                (a)    a focussed psychological strategies health service;

               (b)    an occupational therapy health service.

                eligible optometrist means a person who is an allied health professional in relation to the provision of an optometry health service.

                eligible orthoptist means a person who is an allied health professional in relation to the provision of an orthoptic health service. 

eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.

eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.

eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.

eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:

                (a)    a focussed psychological strategies health service;

               (b)    a non‑directive pregnancy support counselling health service;

                (c)    a psychology health service.

eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:

                (a)    a focussed psychological strategies health service;

               (b)    a non‑directive pregnancy support counselling health service.

eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.

focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑ based psychological therapies:

                (a)    psycho‑education;

               (b)    cognitive‑behavioural therapy that involves cognitive or behavioural interventions;

                (c)    relaxation strategies;

               (d)    skills training;

                (e)    interpersonal therapy;

                (f)    narrative therapy (for Aboriginal and Torres Strait Islander people).

focussed psychological strategies continuing professional development means the completion of 10 continuing professional development units per CPD year, each unit being 1 hour that relate to the delivery of focussed psychological strategies in any of the following areas:

                (a)    psycho‑education;

               (b)    cognitive‑behavioural therapy including;

                                                (i) behavioural interventions;

                                                (ii) behaviour modification;

                                                (iii) exposure techniques;

                                                (iv) activity scheduling;

(c)     cognitive interventions including:

                     (i) cognitive therapy;

               (d)                relaxation strategies including;

                                                (i) progressive muscle relaxation;

                                                (ii) controlled breathing;

                (e)    skills training including;

                                                (i) problem solving skills and training;

                                                (ii) anger management;

                                                (iii) social skills training;

                                                (iv) communication training;

                                                (v) stress management;

                                                (vi) parent management training;

                (f)    interpersonal therapy;

                (g)   narrative therapy (for Aboriginal and Torres Strait Islander people);

                (h)   clinical skills to undertake a full assessment of a patient in order to form a diagnosis and commence treatment planning.

GP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the general medical services table applies.

GP Mental Health Treatment Plan, for a patient, means:

(a)  a GP Mental Health Treatment Plan for the patient made before     1 November 2011 to which item 2702 or 2710 of the general medical services table as in force on 31 October 2011 applies; or

 (b)   a GP Mental Health Treatment Plan for the patient to which item     2700, 2701, 2715 or 2717 of the general medical services table applies.

multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the general medical services table applies.

National Law means:

                (a)    for a State or Territory other than Western Australia - the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and

               (b)    for Western Australia – the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.

non‑directive pregnancy support counselling has the meaning given in subsection (2).

Occupational Therapy Australia means the national body of the Australian Association of Occupational Therapists.

PDD treatment and management plan, for a child, means a plan for the treatment and management of the child’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies. 

Psychology Board of Australia means that body established under section 31 of the National Law.

relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.

Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or item 732 of the general medical services table applies.

Note   The following terms are defined in subsection 3 (1) of the Act:

·      dental practitioner

·      general medical services table

·      medical practitioner       

·      Chief Executive Medicare

·         participating optometrist

·      professional service.

         (2)   A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a woman by a health professional in which:

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

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

5              Treatment of allied health services

                An allied health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:

                (a)    it were both a professional service and a medical service; and

               (b)    there were an item in the general medical services table that:

                          (i)    related to the service; and

                         (ii)    specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.

Note   For this Determination, an internal Territory is deemed to form part of the State of New South Wales  — see subsection 3C (7) of the Act.

6              Limitation on certain individual items

 

(1)          This section applies to items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.

(2)          From 1 March 2012 until midnight 31 December 2012, for any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is:

(a)    one of the first 10 relevant services provided to the patient in the calendar year; or

(b)    if exceptional circumstances exist in relation to the patient – one of the first 16 relevant services provided to the patient in the calendar year. 

(3)          From 1 January 2013, for any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient in the calendar year.

(4)          In this section:

 

(a)    exceptional circumstances exist in relation to a patient if:

(i) the patient has, in a calendar year, received at least 10 relevant services; and

(ii) the patient’s referring medical practitioner is satisfied that there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for a service described in an item mentioned in the definition of relevant service; and

(b)    relevant service means a service to which any of items 2721 to 2727 of the general medical services table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply.

 

6A           Limitation on certain group items

        (1)   For any particular patient, an item mentioned in subsection (2) applies in a    calendar year only if the service described in the item is one of the first 10 services mentioned in items in subsection (2) provided to the patient in the calendar year.

(2)     The items are items 80020, 80120, 80145 and 80170 in Schedule 2.

7              Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services

         (1)   This section applies to items 80000 to 80170 in Schedule 2.

         (2)   The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 293 to 370 of the general medical services table applies.

         (3)   The referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 133 of the general medical services table applies.

         (4)   The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the general medical services table applies.

8              Referrals by psychiatrists and paediatricians for pervasive developmental disorder services

         (1)   This section applies to items 82000 to 82035 in Schedule 2.

         (2)   For items 82000, 82005, 82010 and 82030 the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the general medical services table applies.

         (3)   For items 82000, 82005, 82010 and 82030 the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table applies.

         (4)   For items 82015, 82020, 82025 and 82035 the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the general medical services table applies.

         (5)   If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the general medical services table applies.

(6)    For items 82015, 82020, 82025 and 82035 the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which item 135 of the general medical services table applies.

         (7)   If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the general medical services table applies.

         (8)   If a child has previously been provided with a service mentioned in item 137 or 139, the medical practitioner cannot refer the child for a service to which item 135 or 289 of the general medical services table applies.

8A           Referrals by specialists, consultant physicians and general practitioners for disability services

         (1)   This section applies to items 82000 to 82035 in Schedule 2.  

(2)    For items 82000, 82005, 82010 and 82030 the referral by a specialist or consultant physician specialising in the practice of his or her field of speciality must be a referral for a service to which any of items 104 to 131 or 296 to 370 (except item 359) of the general medical services table apply.

         (3)   For items 82000, 82005, 82010 and 82030 the referral by a general practitioner must be a referral for a service to which any of items 3 to 51 of the general medical services table applies.

 (4)   For items 82015, 82020, 82025 and 82035 the referral by a specialist or consultant physician specialising in the practice of his or her field of speciality must be a referral for a service to which item 137 of the general medical services table applies.

 (5)   For items 82015, 82020, 82025 and 82035 the referral by a general practitioner must be a referral for a service to which item 139 of the general medical services table applies.  

 (6)   If a child has previously been provided with a service mentioned in item 135 or 289, the medical practitioner cannot refer the child for a service to which item 137 or 139 of the general medical services table applies.


9              Effect of election to claim private health insurance for an allied health service

                An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.

 

9A           Pervasive developmental disorder and disability services course of assessment – reporting requirements

 

(1)    This section applies to items 82000, 82005, 82010 and 82030.

 

(2)    At the completion of a course of assessment, the allied health professional must provide a written report to the referring medical practitioner.

10            Focussed Psychological Strategies health services

 

(1)   To comply with this section a person must complete focussed psychological strategies continuing professional development each CPD year.

 

(2) A person referred to in subsection (1) is required to keep written records of completion of focussed psychological strategies continuing professional development for a period of two years from the end of the CPD year to which the focussed psychological strategies continuing professional development relates.

 

(3) For the period referred to in paragraph (a) of the meaning of CPD year in section 4(1), a person who is an allied health professional in relation to the provision of a focussed psychological strategies health service, as at the date of commencement of this Determination, may count for completion of focussed psychological strategies continuing professional development any of the units referred to within the meaning of that term in section 4(1) completed from 1 July 2009 to 30 June 2011.

 

(4)   Other than where subsection (7) applies, where a person seeks to become an allied health professional in relation to the provision of a focussed psychological strategies health service during a CPD year and meets the requirements set out in Schedule 1 for the provision of a focussed psychological strategies health service:

 

(a) that person’s name will be entered on the register, kept by the Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind until the end of that CPD year; and

 

(b) that person will have until the end of that CPD year to meet the focussed psychological strategies continuing professional development on a pro-rata basis, with units being calculated from the first day of the month immediately succeeding the date of registration.

 

(5)   If the Minister is satisfied that an allied health professional in relation to the provision of a focussed psychological strategies health service has not completed their focussed psychological strategies continuing professional development, the Minister:

 

(a) may decide to remove the name of that allied health professional from the register kept by the Chief Executive Medicare; and then

 

(b) notify the Chief Executive Medicare to remove the name from the register.

 

(6)   Before the Minister provides notification under subsection (5)(b), the Minister must notify that allied health professional in writing of the decision setting out:

(a) the decision;

(b) the reasons for the decision; and

(c) a statement of the allied health professional’s reconsideration rights under section 11.

 

(7)   If the name of a person has been removed from the register as an allied health professional in relation to the provision of a focussed psychological strategies health service under subsection (9) in order to become an allied health professional in relation to the provision of a focussed psychological strategies health service (reregistered) that person must apply to be registered and in his or her application must:

 

(a)  provide evidence of attaining the necessary amount of units that he or she was required to attain to comply with the focused psychological strategies continuing professional development in the CPD year in which he or she failed to comply;

 

   and if reregistered must

 

(b) comply with subsection (1) as if the CPD year in which he or she was reregistered commenced on the date of reregistration.

 

(8)  The Minister may grant an exemption in whole or part from focussed psychological strategies continuing professional development, where:

 

(a)  a written application from an allied health professional has been received; and

 

(b)  the Minister is satisfied that special circumstances prevented the allied health professional from completing focussed psychological strategies continuing professional development in a CPD year. 

 

(9)    Upon receiving notification under subsection (5)(b), the Chief Executive Medicare shall not remove the name of an allied health professional from the register until notified either:

 

(a)  under section 11(10) that if the allied health professional has applied      under section 11(1), the Minister has given notice, under section 11(5) that the decision to remove has been affirmed; or

 

(b)  under section 11(10) that, if the allied health professional has applied   under section 11(6), the Minister has given notice under section 11(9)(c); or

 

(c)  where subsections (9)(a) or (b) are not applicable that such period of time as referred to in section 11(2) has expired.

11            Reconsideration of Decision

 

(1)     Where the Minister has provided notification under section 10(6), the allied health professional may apply to the Minister for reconsideration of that decision.

 

(2)        The application must be made in writing:

 

(a)    within 28 days from the date of the decision; or

 

(b)   if the Minister is satisfied that special circumstances exist, within such further period as the Minister, before the expiration of the period referred to in paragraph (a), allows.

 

(3)        The allied health professional must set out the reasons for the application and in doing so, may provide new material for the Minister to consider.

 

(4)        The Minister must, within 28 days after receipt of an application made in accordance with subsection (1), reconsider the decision and make a new decision either:

 

(a) affirming the decision; or

 

(b) setting aside the decision.

 

(5)        The Minister must give the allied health professional notice in writing of the reconsideration decision setting out:

 

(a)  the decision; and

 

(b)  the reasons for the decision.

 

(6)        The allied health professional may, as an alternative to applying for reconsideration of the decision, request further time to complete the number of units required to satisfy the Minister that the allied health professional complies with section 10(1).

 

(7)        If the allied health professional makes a request for further time under subsection (6) that request takes the place of the right to reconsideration under subsection (1).

 

(8)        If the allied health professional makes a request under subsection (6), the period of time in which to complete the number of units required to satisfy the Minister is 28 days, commencing from the date of notification by the Minister that the allied health professional may complete the nominated amount of units.

 

(9)        If, by the end of the period of time referred to in subsection (8), the Minister is not satisfied that the allied health professional has completed the amount of units required to comply with section 10(1), the Minister must:

 

(a) proceed as if the allied health professional had applied under subsection (1);

 

(b) make a decision, which will be regarded as being made under  subsection (4); and

 

(c) give the allied health professional notice in writing of the decision as if the notice was given under subsection (5).

 

(10)      The Minister must provide a written copy of a decision made under this section to the Chief Executive Medicare.

 

 


Schedule 1        Qualification requirements for allied health professionals

(section 4)

  

1

Aboriginal and Torres Strait Islander health service

A person is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service if:

   (a)  for a person who provides an Aboriginal and Torres Strait Islander health service in a State or Territory other than the Northern Territory — the person has been awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework; or

  (b)  for a person who provides an Aboriginal and Torres Strait Islander health service in the Northern Territory — the person is registered under the Health Practitioners Act (NT).

2

Audiology health service

A person is an allied health professional in relation to the provision of an audiology health service if the person is:

   (a)  a Full Member of the Audiological Society of Australia and the holder of a Certificate of Clinical Practice issued by that Society; or

  (b)  an Ordinary Member — Audiologist, or a Fellow Audiologist, of the Australian College of Audiology.

3

Chiropractic health service

A person is an allied health professional in relation to the provision of a chiropractic health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

4

Diabetes education health service

A person is an allied health professional in relation to the provision of a diabetes education health service if the person is credentialled by the Australian Diabetes Educators Association as a ‘Credentialled Diabetes Educator’.

5

Dietetics health service

A person is an allied health professional in relation to the provision of a dietetics health service if the person is accredited by the Dietitians Association of Australia as an ‘Accredited Practising Dietitian’.

6

Exercise physiology health service

A person is an allied health professional in relation to the provision of an exercise physiology health service if the person is accredited by the Exercise and Sports Science Australia as an ‘Accredited Exercise Physiologist’.

7

Focussed psychological strategies health service

A person is an allied health professional in relation to the provision of a focussed psychological strategies health service if the person meets one of the following requirements:

   (a)  the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;

  (b)  the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008;

   (c)  the person:

         (i)   is a Full‑time Member, or a Part‑time Member, Occupational Therapy Australia; and

        (ii)   is, for a person who provides a focussed psychological strategies health service in Queensland, Western Australia, South Australia or the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and

       (iii)   has a minimum of 2 years experience in mental health; and

       (iv)   has given an undertaking to Occupational Therapy Australia to observe the standards set out in the document published by Occupational Therapy Australia titled ‘Australian Competency Standards for Occupational Therapists in Mental Health’, as in force on 1 November 2006.

Note: Allied health professionals in relation to the provision of a focussed psychological strategies health service are subject to the requirements of section 10.

 

8

Mental health service

A person is an allied health professional in relation to the provision of a mental health service if the person meets one of the following requirements:

   (a)  the person meets the requirements specified for an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service;

  (b)  the person is a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses;

   (c)  the person is:

         (i)   for a person who provides a mental health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of Occupational Therapy Australia; and

        (ii)   for a person who is an occupational therapist and provides a mental health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;

  (d)  the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;

 

   (e)  the person is:

         (i)   a Member of the Australian Association of Social Workers; and

        (ii)   certified by that Association as meeting the standards for mental health set out in the document published by that Association titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008.

9

Non‑directive pregnancy support counselling health service

A person is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service if the person meets one of the following requirements:

   (a)  the person is certified by the Australian College of Mental Health Nurses:

         (i)   as a credentialled mental health nurse; and

        (ii)   as appropriately trained in non‑directive pregnancy counselling;

  (b)  the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided and is certified by the Australian Psychological Society as appropriately trained in non-directive pregnancy counselling;

   (c)  the person is:

         (i)   a member of the Australian Association of Social Workers (AASW); and

        (ii)   certified by AASW either as meeting the standards for mental health set out in the document published by that Association titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008 or as an accredited social worker; and

       (iii)   certified by AASW as appropriately trained in non‑directive pregnancy counselling.

For this health service, a person is appropriately trained in non‑directive pregnancy counselling if the person has undergone training based on the key criteria contained in the document published by the Department titled ‘Key criteria for non‑directive pregnancy counselling training provided to GPs and allied health professionals in relation to the Medicare non‑directive pregnancy support counselling items’, as in force on 1 November 2006.

10

Occupational therapy health service

A person is an allied health professional in relation to the provision of an occupational therapy health service if the person is:

   (a)  for a person who provides an occupational therapy health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of Occupational Therapy Australia; and

  (b)  for a person who provides an occupational therapy health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

11

Optometry health service

A person is an allied health professional in relation to the provision of an optometry health service if the person is a participating optometrist.

12

Orthoptic health service

A person is an allied health professional in relation to the provision of an orthoptic health service if the person is:

   (a)  registered with the Australian Orthoptic Board and has a Certificate of Currency; and

   (b)  a member of Orthoptics Australia.

13

Osteopathy health service

A person is an allied health professional in relation to the provision of an osteopathy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

14

Physiotherapy health service

A person is an allied health professional in relation to the provision of a physiotherapy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

15

Podiatry health service

A person is an allied health professional in relation to the provision of a podiatry health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

16

Psychological therapy health service

A person is an allied health professional in relation to the provision of a psychological therapy health service if the person:

   (a)  is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and

  (b)  either:

         (i)   is a member of the College of Clinical Psychologists of the Australian Psychological Society (APS): or

        (ii)   has been assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements; or

       (iii)   is endorsed by the Psychology Board of Australia to practice in clinical psychology.

17

Psychology health service

A person is an allied health professional in relation to the provision of a psychology health service if the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

18

Speech pathology health service

A person is an allied health professional in relation to the provision of a speech pathology health service if the person is:

   (a)  for a person who provides a speech pathology health service in a State or Territory other than Queensland — a Practising Member of Speech Pathology Australia; and

  (b)  for a person who provides a speech pathology health service in Queensland — registered as a person who may provide that kind of service under the applicable law in force in Queensland.

Schedule 2        Allied health services

(section 6)

Part 1          Services and fees — general

Item

Service

Fee ($)

10950

Aboriginal and Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible Aboriginal health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

 

10951

Diabetes education health service provided to a person by an eligible diabetes educator if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

61.10

 

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

 

 

   (c)  the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10952

Audiology health service provided to a person by an eligible audiologist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and          (c)        the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

61.10

 

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

 

 

   (g)  after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

 

 

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10953

Exercise physiology health service provided to a person by an eligible exercise physiologist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

 

10954

Dietetics health service provided to a person by an eligible dietitian if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

61.10

 

   (c)  the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10956

Mental health service provided to a person by an eligible mental health worker if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

61.10

 

   (c)  the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

 

 

   (g)  after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

(iii)  if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10958

Occupational therapy health service provided to a person by an eligible occupational therapist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

61.10

 

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10960

Physiotherapy health service provided to a person by an eligible physiotherapist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

10962

Podiatry health service provided to a person by an eligible podiatrist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

61.10

 

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

 

 

   (g)  after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or     

(iii)  if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10964

Chiropractic health service provided to a person by an eligible chiropractor if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

61.10

 

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10966

Osteopathy health service provided to a person by an eligible osteopath if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

10968

Psychology health service provided to a person by an eligible psychologist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

61.10

 

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

10970

Speech pathology health service provided to a person by an eligible speech pathologist if:

   (a)  the service is provided to a person who has:

         (i)   a chronic condition; and

        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)  the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

   (c)  the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

61.10

 

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 20 minutes duration; and

   (g)  after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

         (i)   if the service is the only service under the referral — in relation to that service; or

 

 

        (ii)   if the service is the first or last service under the referral — in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of  — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar year

This item is subject to section 9

 

Part 2          Services and fees — psychological therapy and focussed psychological strategies

Item

Service

Fee ($)

80000

Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

   (c)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

  (d)  the service is at least 30 minutes but less than 50 minutes duration

This item is subject to sections 6, 7 and 9

97.90

80005

Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80000

This item is subject to sections 6, 7 and 9

122.35

 

80010

Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

143.70

 

   (c)  on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

  (d)  the service is at least 50 minutes duration

This item is subject to sections 6, 7 and 9

 

80015

Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80010

This item is subject to sections 6, 7 and 9

168.15

80020

Psychological therapy health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided in person; and

  (b)  the service is at least 60 minutes duration;

This item is subject to sections 6A, 7 and 9

36.50

80100

Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

69.35

 

   (c)  on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

 

 

  (d)  the service is at least 20 minutes but less than 50 minutes duration

This item is subject to sections 6, 7 and 9

 

80105

Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80100

This item is subject to sections 6, 7 and 9

94.35

80110

Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

   (c)  on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

  (d)  the service is at least 50 minutes duration

This item is subject to sections 6, 7 and 9

97.90

80115

Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80110

This item is subject to sections 6, 7 and 9

122.95

80120

Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided in person; and

25.00

 

  (b)  the service is at least 60 minutes duration;

This item is subject to sections 6A, 7 and 9

 

80125

Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

   (c)  on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

  (d)  the service is at least 20 minutes but less than 50 minutes duration

This item is subject to sections 6, 7 and 9

61.10

80130

Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item 80125

This item is subject to sections 6, 7 and 9

86.05

80135

Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

86.30

 

   (c)  on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

  (d)  the service is at least 50 minutes duration

This item is subject to sections 6, 7 and 9

 

80140

Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item 80135

This item is subject to sections 6, 7 and 9

111.25

80145

Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided in person; and

  (b)  the service is at least 60 minutes duration;

This item is subject to sections 6A, 7 and 9

21.95

80150

Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

61.10

 

   (c)  on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

 

 

  (d)  the service is at least 20 minutes but less than 50 minutes duration

This item is subject to sections 6, 7 and 9

 

80155

Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80150

This item is subject to sections 6, 7 and 9

86.05

80160

Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(aa)  the service is provided to the person individually and in person; and

  (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

   (c)  on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

  (d)  the service is at least 50 minutes duration

This item is subject to sections 6, 7 and 9

86.30

80165

Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80160

This item is subject to sections 6, 7 and 9

111.25

80170

Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

21.95

 

(aa)  the service is provided in person; and

 

 

  (b)  the service is at least 60 minutes duration;

This item is subject to sections 6A, 7 and 9

 

Part 3          Services and fees — pregnancy support counselling

Item

Service

Fee ($)

81000

Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible psychologist if:

   (a)  the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

  (b)  the woman is referred by a medical practitioner who is not a specialist or consultant physician; and

(ba)  the service is provided to the woman individually and in person; and

   (c)  the eligible psychologist does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

  (d)  the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy

The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate

This item is subject to section 9

[* in the general medical services table]

71.80

81005

Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible social worker if:

   (a)  the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

  (b)  the woman is referred by a medical practitioner who is not a specialist or consultant physician; and

(ba)  the service is provided to the woman individually and in person; and

   (c)  the eligible social worker does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

  (d)  the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy

The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate

This item is subject to section 9

[* in the general medical services table]

71.80

81010

Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible mental health nurse if:

   (a)  the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

  (b)  the woman is referred by a medical practitioner who is not a specialist or consultant physician; and

(ba)  the service is provided to the woman individually and in person; and

   (c)  the eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

  (d)  the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy

The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate

This item is subject to section 9

[* in the general medical services table]

71.80

Part 4          Services and fees — group services

Division 4.1    Diabetes education services

 

Item

Service

Fee ($)

81100

Diabetes education health service provided to a person by an eligible diabetes educator for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

   (a)  the person has type 2 diabetes; and

  (b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

   (c)  the person is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 45 minutes duration; and

   (g)  after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)

This item is subject to section 9

78.35

81105

Diabetes education health service provided to a person by an eligible diabetes educator, as a group service for the management of type 2 diabetes if:

   (a)  the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and

  (b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided in person; and

   (e)  the service is of at least 60 minutes duration; and

19.55

 

   (f)  after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

 

 

   (g)  an attendance record for the group is maintained by the eligible diabetes educator;

to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)

This item is subject to section 9

 

Division 4.2    Exercise physiology services

 

Item

Service

Fee ($)

81110

Exercise physiology health service provided to a person by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

   (a)  the person has type 2 diabetes; and

  (b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

   (c)  the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

   (f)  the service is of at least 45 minutes duration; and

   (g)  after the service, the eligible exercise physiologist gives a
written report to the referring medical practitioner mentioned
in
paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)

This item is subject to section 9

78.35

81115

Exercise physiology health service provided to a person by an eligible exercise physiologist, as a group service for the management of type 2 diabetes if:

   (a)  the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and

  (b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided in person; and

19.55

 

   (e)  the service is of at least 60 minutes duration; and

   (f)  after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

   (g)  an attendance record for the group is maintained by the eligible exercise physiologist;

to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)

This item is subject to section 9

 

Division 4.3    Dietetics services

 

Item

Service

Fee ($)

81120

Dietetics health service provided to a person by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

   (a)  the person has type 2 diabetes; and

  (b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

   (c)  the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is provided to the person individually and in person; and

78.35

 

   (f)  the service is of at least 45 minutes duration; and

   (g)  after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)

This item is subject to section 9

 

81125

Dietetics health service provided to a person by an eligible dietitian, as a group service for the management of type 2 diabetes if:

   (a)  the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and

  (b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided in person; and

19.55

 

   (e)  the service is of at least 60 minutes duration; and

   (f)  after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

   (g)  an attendance record for the group is maintained by the eligible dietitian;

to a maximum of 8 group services in a calendar year (including services to which items 81105, 81115 and 81125 apply)

This item is subject to section 9

 

Part 5          Services and fees — pervasive developmental disorder or disability services

Item

Service

Fee ($)

82000

Psychology health service provided to a child aged under 13 years by an eligible psychologist if:

   (a)  the child was referred to the eligible psychologist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner; or

        (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

  (b)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; or

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

   (c)  the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

  (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82005, 82010 and 82030 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A, 9 and 9A

97.90

82005

Speech pathology health service provided to a child aged under 13 years by an eligible speech pathologist if:

   (a)  the child was referred to the eligible speech pathologist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner: or

        (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

  (b)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

   (c)  the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

  (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82000, 82010 and 82030 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A, 9 and 9A

86.30

82010

Occupational therapy health service provided to a child aged under 13 years by an eligible occupational therapist if:

   (a)  the child was referred to the eligible occupational therapist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner: or

        (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

  (b)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her field of specialty, or a general practitioner; and

   (c)  the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

  (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82000, 82005 and 82030 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A, 9 and 9A

86.30

82015

Psychology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible psychologist, if:

   (a)  the child has been diagnosed with a PDD or an eligible disability; and

  (b)  the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

  (d)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her field of specialty, or a general practitioner; and

   (e)  the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

   (f)  on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

   (g)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

  (h)  the child is not an admitted patient of a hospital; and

   (i)  the service is provided to the child individually and in person; and

   (j)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82020, 82025 and 82035 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A and 9

97.90

82020

Speech pathology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible speech pathologist, if:

   (a)  the child has been diagnosed with a PDD or an eligible disability; and

  (b)  the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

  (d)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

   (e)  the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

   (f)  on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

   (g)  the child is not an admitted patient of a hospital; and

  (h)  the service is provided to the child individually and in person; and

   (i)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82015, 82025 and 82035 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A and 9

86.30

82025

Occupational therapy health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible occupational therapist if:

   (a)  the child has been diagnosed with a PDD or an eligible disability; and

  (b)  the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

  (d)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

   (e)  the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

   (f)  on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

86.30

 

   (g)  the child is not an admitted patient of a hospital; and

  (h)  the service is provided to the child individually and in person; and

   (i)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82015, 82020 and 82035 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A and 9

 

82030

Audiology, optometry, orthoptic or physiotherapy health service provided to a child aged under 13 years by an eligible audiologist, optometrist, orthoptist or physiotherapist if:

   (a)  the child was referred to the eligible audiologist, optometrist, orthoptist or physiotherapist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner; or

        (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

  (b)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

   (c)  the eligible audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

  (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82000, 82005 and 82010 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A, 9 and 9A

86.30

82035

Audiology, optometry, orthoptic or physiotherapy health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible audiologist, optometrist, orthoptist or physiotherapist, if:

   (a)  the child has been diagnosed with a PDD or an eligible disability; and

  (b)  the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

  (d)  the eligible practitioner is:

(i)    for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)   for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

   (e)  the eligible audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

   (f)  on the completion of the course of treatment, the eligible audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

   (g)  the child is not an admitted patient of a hospital; and

  (h)  the service is provided to the child individually and in person; and

   (i)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82015, 82020 and 82025 apply)

Up to 4 services may be provided to the same child on the same day

This item is subject to sections 8, 8A and 9

86.30

 

 

 

Part 6          Services and fees — Aboriginal and Torres Strait Islander services

Item

Service

Fee ($)

81300

Aboriginal and Torres Strait Islander health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible Aboriginal health worker if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible Aboriginal health worker by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81305

Diabetes education health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible diabetes educator if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible diabetes educator by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

61.10

 

   (f)  after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

 

 

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

 

81310

Audiology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible audiologist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible audiologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81315

Exercise physiology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible exercise physiologist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible exercise physiologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

61.10

 

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

 

81320

Dietetics health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible dietitian if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible dietitian by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81325

Mental health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible mental health worker if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible mental health worker by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

61.10

 

   (f)  after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (b):

 

 

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

 

81330

Occupational therapy health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible occupational therapist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible occupational therapist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

61.10

 

   (f)  after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

 

81335

Physiotherapy health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible physiotherapist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible physiotherapist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

61.10

 

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

 

81340

Podiatry health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible podiatrist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible podiatrist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81345

Chiropractic health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible chiropractor if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible chiropractor by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81350

Osteopathy health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible osteopath if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible osteopath by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81355

Psychology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible psychologist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible psychologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

61.10

81360

Speech pathology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible speech pathologist if:

   (a)  a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

  (b)  the person is referred to the eligible speech pathologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

   (c)  the person is not an admitted patient of a hospital; and

  (d)  the service is provided to the person individually and in person; and

   (e)  the service is of at least 20 minutes duration; and

   (f)  after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (b):

         (i)   if the service is the only service under the referral — in relation to that service; or

        (ii)   if the service is the first or the last service under the referral – in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;

to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year

This item is subject to section 9

 

61.10

 


 


 

 

 

 

 

Notes to the Health Insurance (Allied Health Services) Determination 2011

Note 1

The Health Insurance (Allied Health Services) Determination 2011 (in force under subsection 3C (1) of the Health Insurance Act 1973) as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title

Date of FRLI registration

Date of
commencement

Application, saving or
transitional provisions

Health Insurance (Allied Health Services) Determination 2011

20 Jun 2011 (see F2011L01080)

1 Jul 2011

Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 2)

26 Oct 2011 (see F2011L02134)

1 Nov 2011

Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1)

6 Feb 2012 (see F2012L00172)

1 March 2012

 


 

 

 

 

 

Table of Amendments

 

ad.  = added or inserted       am. = amended       rep. = repealed     rs. = repealed and substituted

Provision affected

How affected

S. 4(1)……………………

am. 2011 No. 2

 

S. 6……………………….

rs.   2011 No. 2; 2012 No. 1

 

S. 6A……………………..

ad.  2011 No. 2

 

 

Schedule 2

 

Schedule 2………………..

am.  2011 No. 2