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Primary content

SLI 2014 No. 80 Regulations as amended, taking into account amendments up to Health Insurance Legislation Amendment (Optometric Services and Other Measures) Regulation 2014
Administered by: Health
Registered 08 Jan 2015
Start Date 01 Jan 2015
End Date 01 Jul 2015
Date of repeal 01 Jul 2015
Repealed by Health Insurance (General Medical Services Table) Regulation 2015
Table of contents.

Health Insurance (General Medical Services Table) Regulation 2014

No. 80, 2014

made under the

Health Insurance Act 1973

Compilation No. 2

Compilation date:                              1 January 2015

Includes amendments up to:            SLI No. 195, 2014

Registered:                                         8 January 2015

 

 

 

 

 

 

 

 

 

This compilation includes commenced amendments made by SLI No. 148, 2014; SLI No. 149, 2014

About this compilation

This compilation

This is a compilation of the Health Insurance (General Medical Services Table) Regulation 2014 that shows the text of the law as amended and in force on 1 January 2015 (the compilation date).

This compilation was prepared on 6 January 2015.

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on ComLaw (www.comlaw.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on ComLaw for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on ComLaw for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

  

  

  


Contents

1............................ Name of regulation............................................................. 1

3............................ Authority............................................................................ 1

4............................ Schedule(s)......................................................................... 1

5............................ General medical services table............................................ 1

6............................ Dictionary........................................................................... 1

7............................ Transitional provisions....................................................... 1

Schedule 1—General medical services table                                       2

Part 1—Preliminary                                                                                                             2

Division 1.1—Interpretation                                                                                     2

1.1.1...................... Meaning of eligible non‑vocationally recognised medical practitioner    2

1.1.1A................... Meaning of general practitioner......................................... 4

1.1.2...................... Meaning of multidisciplinary case conference.................... 4

1.1.3...................... Meaning of multidisciplinary case conference team........... 5

1.1.4...................... Meaning of single course of treatment............................... 6

1.1.5...................... Meaning of symbol (G)...................................................... 7

1.1.6...................... Meaning of symbol (H)...................................................... 7

1.1.7...................... Meaning of symbol (S)....................................................... 7

Division 1.2—General application provisions                                                 9

1.2.1...................... Application......................................................................... 9

1.2.2...................... Attendance by specialist or consultant physician................ 9

1.2.3...................... Professional attendance services....................................... 10

1.2.4...................... Personal attendance by medical practitioners generally..... 10

1.2.5...................... Personal attendance by medical practitioners.................... 11

1.2.6...................... Consultant occupational physician.................................... 12

1.2.7...................... Application of items—services provided with non‑medicare services     13

1.2.7A................... Application of items—services provided with autologous injections of blood or blood products            13

1.2.8...................... Services that may be provided by persons other than medical practitioners             13

1.2.9...................... Meaning of participating in a video conferencing consultation               14

Part 2—Services and fees                                                                                                15

Division 2.1—Groups A1 to A10                                                                          15

2.1.1...................... Meaning of amount under clause 2.1.1............................ 15

Division 2.2—Group A1: General practitioner attendances to which no other item applies     18

Division 2.3—Group A2: Other non‑referred attendances to which no other item applies       23

2.3.1...................... Effect of determination under section 106TA of Act........ 23

Division 2.4—Group A3: Specialist attendances to which no other item applies             27

2.4.1...................... Limitation of item 99......................................................... 27

Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies                                                                                            30

2.5.1...................... Limitation of items 112 to 114.......................................... 30

Division 2.5A—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability                                        35

2.5A.1................... Meanings of eligible allied health provider and risk assessment             35

2.5A.2................... Meaning of eligible disability............................................ 35

Division 2.6—Group A28: Geriatric medicine                                             40

2.6.1...................... Limitation of item 149....................................................... 40

Division 2.7—Group A5: Prolonged attendances to which no other item applies           45

2.7.1...................... Application of items 160 to 164........................................ 45

Division 2.8—Group A6: Group therapy                                                        46

Division 2.9—Group A7: Acupuncture                                                             47

2.9.1...................... Meaning of qualified medical acupuncturist..................... 47

Division 2.10—Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies                                                                               50

2.10.1.................... Application of items 291, 293 and 359............................. 50

2.10.2.................... Application of items 342, 344 and 346............................. 50

2.10.3.................... Restriction of telepsychiatry consultations to regional, rural and remote areas         50

2.10.4.................... Limitation of item 288....................................................... 50

2.10.5.................... Meanings of eligible allied health provider and risk assessment             50

Division 2.11—Group A12: Consultant occupational physician attendances to which no other item applies                                                                                                       66

2.11.1.................... Limitation of items 384 and 389....................................... 66

Division 2.12—Group A13: Public health physician attendances to which no other item applies           69

2.12.1.................... Public health physicians.................................................... 69

Division 2.13—Miscellaneous services                                                              73

Division 2.14—Group A21: Emergency physician attendances to which no other item applies              74

2.14.1.................... Meaning of recognised emergency department................ 74

2.14.2.................... Meaning of problem focussed history.............................. 74

2.14.3.................... Attendance for emergency evaluation of critically ill patients 74

Division 2.15—Group A11: Urgent attendances after hours               79

2.15.1.................... Meaning of patient’s medical condition requires urgent treatment         79

2.15.2.................... Meaning of responsible person........................................ 79

2.15.3.................... Application of Group A11................................................ 80

2.15.4.................... Effect of determination under section 106TA of Act........ 80

Division 2.16—Group A14: Health assessments                                          83

2.16.1.................... Application of Group A14................................................ 83

2.16.2.................... Types of health assessments............................................. 83

2.16.3.................... Application of item 715 to certain patients only................ 85

2.16.4.................... Healthy Kids Check.......................................................... 86

2.16.5.................... Type 2 Diabetes Risk Evaluation...................................... 87

2.16.6.................... 45 year old Health Assessment......................................... 88

2.16.7.................... Older Person’s Health Assessment.................................. 89

2.16.8.................... Comprehensive Medical Assessment for permanent resident of residential aged care facility  90

2.16.9.................... Health assessment for a person with an intellectual disability  91

2.16.10.................. Health assessment for a refugee or other humanitarian entrant 94

2.16.10A............... Australian Defence Force Post‑discharge GP Health Assessment           95

2.16.11.................. Aboriginal and Torres Strait Islander child health assessment 97

2.16.12.................. Aboriginal and Torres Strait Islander adult health assessment 99

2.16.13.................. Aboriginal and Torres Strait Islander Older Person’s Health Assessment               101

2.16.14.................. Restrictions on health assessments for Group A14........ 103

Division 2.17—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences                                                          106

Subdivision A—General                                                                                       106

2.17.1.................... Service by medical practitioners...................................... 106

Subdivision B—Subgroup 1 of Group A15                                                      106

2.17.2.................... Meaning of associated medical practitioner................... 106

2.17.3.................... Meaning of contribute to a multidisciplinary care plan.. 106

2.17.4.................... Meaning of coordinating the development of team care arrangements   107

2.17.5.................... Meaning of coordinating a review of team care arrangements               108

2.17.6.................... Meaning of multidisciplinary care plan.......................... 109

2.17.7.................... Meaning of preparing a GP management plan.............. 110

2.17.8.................... Meaning of reviewing a GP management plan.............. 111

2.17.9.................... Application of items 721, 723, 729, 731 and 732........... 111

2.17.10.................. Application of items 701 to 723 and 732........................ 113

2.17.10A............... Application of items in relation to items 721, 723 and 732 113

2.17.11.................. Limitation on items 721, 723, 729, 731 and 732............. 113

Subdivision C—Subgroup 2 of Group A15                                                      117

2.17.12.................. Meaning of multidisciplinary discharge case conference 117

2.17.13.................. Meaning of multidisciplinary case conference in a residential aged care facility    117

2.17.14.................. Meaning of organise and coordinate............................. 117

2.17.15.................. Meaning of participate................................................... 118

2.17.16.................. Meaning of coordinating................................................ 119

2.17.17.................. Meaning of case conference team................................... 119

2.17.18.................. Application of item 880.................................................. 120

Division 2.18—Group A17: Domiciliary and residential medication management reviews       128

2.18.1.................... Meaning of living in a community setting....................... 128

2.18.2.................... Meaning of residential medication management review. 128

2.18.3.................... Application of items 900 and 903................................... 129

Division 2.18A—Group A30: Medical practitioner video conferencing consultation   131

2.18A.1................. Application of items........................................................ 131

2.18A.2................. Application of items 2125, 2138, 2179 and 2220........... 131

2.18A.3................. Meaning of amount under clause 2.18A.3...................... 131

2.18A.4................. Limitation of items.......................................................... 132

Division 2.19—Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies)                                                                                                   139

2.19.1.................... Application of Subgroup 2 of Groups A18 and A19..... 139

2.19.2.................... Application of Subgroup 3 of Groups A18 and A19..... 141

Division 2.20—Group A20: Mental health care                                        154

2.20.1.................... Definitions...................................................................... 154

2.20.2.................... Meaning of amount under clause 2.20.2........................ 154

2.20.3.................... Meaning of preparation of a GP mental health treatment plan               155

2.20.4.................... Meaning of review of a GP mental health treatment plan 157

2.20.5.................... Meaning of associated medical practitioner................... 158

2.20.6.................... Application of Subgroup 1 of Group A20...................... 158

2.20.7.................... Focussed psychological strategies.................................. 160

Division 2.21—Group A24: Palliative and pain medicine                     164

2.21.1.................... Meaning of organise and coordinate............................. 164

2.21.2.................... Meaning of participate................................................... 164

2.21.3.................... Application of Group A24.............................................. 165

2.21.4.................... Limitation on items......................................................... 165

2.21.5.................... Limitation of items.......................................................... 166

Division 2.22—Group A27: Pregnancy support counselling               175

2.22.1.................... Application of item 4001................................................ 175

Division 2.23—Group A22: General practitioner after‑hours attendances to which no other item applies                                                                                                                    177

2.23.1.................... Application of Group A22.............................................. 177

Division 2.24—Group A23: Other non‑referred after‑hours attendances to which no other item applies                                                                                                                    183

2.24.1.................... Application of Group A23.............................................. 183

Division 2.26—Group A26: Neurosurgery attendances to which no other item applies              187

2.26.1.................... Limitation of items 6004 and 6016................................. 187

Division 2.27—Group A9: Contact lenses                                                     190

2.27.1.................... Application of item 10809.............................................. 190

Division 2.28—Group A10: Optometric services provided by participating optometrist           193

2.28.1.................... Applications of items 10940 and 10941......................... 193

2.28.2.................... Application of item 10929.............................................. 193

2.28.3.................... Limitation on items......................................................... 193

2.28.4.................... Application of items 10931, 10932 and 10933............... 194

2.28.5.................... Limitation of item 10943................................................. 194

2.28.6.................... Meaning of old item 10900............................................. 194

Division 2.29—Miscellaneous services                                                            204

Division 2.30—Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner                                                                                                                    205

2.30.1.................... Definitions for item 10997.............................................. 205

2.30.2.................... Application of item 10986.............................................. 205

2.30.3.................... Restrictions on item 10986............................................. 206

2.30.4.................... Application of item 10988.............................................. 206

2.30.5.................... Application of item 10989.............................................. 207

2.30.6.................... Limitation of item 10983................................................. 207

Division 2.31—Group M1: Management of bulk‑billed services      211

2.31.1.................... Definitions for Division 2.31.......................................... 211

2.31.2.................... Application of items 10990, 10991 and 10992............... 213

Division 2.33—Diagnostic procedures and investigations                    215

Division 2.34—Group D1: Miscellaneous diagnostic procedures and investigations     216

2.34.1.................... Meaning of report.......................................................... 216

2.34.2.................... Meaning of qualified sleep medicine practitioner........... 216

Division 2.35—Group D2: Nuclear medicine (non‑imaging)               243

2.35.1.................... Application of Group D2................................................ 243

Division 2.37—Group T1: Miscellaneous therapeutic procedures  245

2.37.1.................... Meaning of comprehensive hyperbaric medicine facility 245

2.37.2.................... Meaning of embryology laboratory services.................. 246

2.37.3.................... Meaning of treatment cycle............................................. 246

2.37.4.................... Items provided as part of treatment cycle relating to assisted reproductive services not to apply             246

2.37.5.................... Application of items 13020 to 14245.............................. 247

2.37.6.................... Limitation on item 13104................................................ 247

2.37.7.................... Items relating to assisted reproductive services not to apply in certain pregnancy‑related circumstances 247

2.37.8.................... Application of items 14227 to 14242.............................. 247

2.37.9.................... Application of item 14245.............................................. 248

2.37.10.................. Limitation of item 13210................................................. 248

Division 2.38—Group T2: Radiation oncology                                          264

2.38.1.................... Meaning of amount under clause 2.38.1........................ 264

2.38.2.................... Meaning of approved site............................................... 265

2.38.3.................... Application of Group T2................................................ 265

2.38.4.................... Application of items 15556, 15559 and 15562............... 265

Division 2.39—Group T3: Therapeutic nuclear medicine                    279

2.39.1.................... Application of Group T3................................................ 279

Division 2.40—Group T4: Obstetrics                                                              281

2.40.1.................... Definitions for item 16400.............................................. 281

2.40.2.................... Meaning of amount under clause 2.40.2........................ 281

2.40.3.................... Meaning of delivery........................................................ 282

2.40.4.................... Application of Group T4................................................ 282

2.40.5.................... Application of item 16400.............................................. 282

2.40.5A................. Limitation of item 16399................................................. 283

2.40.6.................... Limitation of items 16590 and 16591............................. 283

Division 2.41—Group T6: Examination by anaesthetist                       290

2.41.1.................... Application of Group T6................................................ 290

2.41.2.................... Limitation of item 17609................................................. 290

Division 2.42—Group T7: Regional or field nerve blocks                   294

2.42.1.................... Meaning of amount under clause 2.42.1........................ 294

2.42.2.................... Application of Group T7................................................ 294

Division 2.42A—Group T11: Botulinum toxin                                           298

2.42A.1................. Injection of botulinum toxin............................................ 298

2.42A.2................. Limitation of items 18360 and 18364............................. 298

Division 2.43—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)                                                                                                     304

2.43.1.................... Meaning of amount under clause 2.43.1........................ 304

2.43.2.................... Meaning of amount under clause 2.43.2........................ 305

2.43.3.................... Meaning of complex paediatric case.............................. 305

2.43.4.................... Meaning of service time.................................................. 306

2.43.5.................... Application of Group T10.............................................. 306

2.43.6.................... Application of Subgroup 21 of Group T10.................... 307

2.43.7.................... Services mentioned in Subgroups 21 to 25 of Group T10 307

2.43.8.................... Application of Subgroups 22 and 23 of Group T10....... 307

2.43.9.................... Application of Subgroups 24 and 25 of Group T10....... 308

Division 2.44—Group T8: Surgical operations                                          352

Subdivision A—General                                                                                       352

2.44.1.................... Meaning of approved site............................................... 352

2.44.2.................... Application of Group T8................................................ 352

Subdivision B—Subgroup 1 of Group T8                                                        352

2.44.4.................... Meaning of amount under clause 2.44.4........................ 352

2.44.5.................... Meaning of amount under clause 2.44.5........................ 352

2.44.6.................... Meaning of qualified surgeon......................................... 353

2.44.7.................... Meaning of qualified radiologist.................................... 353

2.44.8.................... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures...................................................................... 353

2.44.9.................... Application of items 30299 and 30300........................... 354

2.44.10.................. Application of items 30440, 30451, 30492 and 30495... 354

2.44.11.................. Application of items 30688, 30690, 30692 and 30694... 354

2.44.12.................. Application of item 35412.............................................. 354

2.44.12A............... Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590            354

Subdivision C—Subgroups 2 and 3 of Group T8                                           411

2.44.13.................. Meaning of foreign body in items 35360 to 35363......... 411

2.44.14.................. Application of items 32500 to 32517 and 35321............ 411

2.44.15.................. Application of items 35404, 35406 and 35408............... 411

2.44.15A............... Sacral nerve stimulation.................................................. 412

2.44.15B................ Artificial bowel sphincter................................................ 412

Subdivision D—Subgroups 4, 5 and 6 of Group T8                                       442

2.44.17.................. Application of items 38470 to 38766.............................. 442

Subdivision E—Subgroups 7 to 11 of Group T8                                            495

Subdivision F—Subgroups 12 and 13                                                               536

2.44.18.................. Meaning of amount under clause 2.44.18...................... 536

2.44.19.................. Meaning of maxilla......................................................... 536

Subdivision G—Subgroup 14                                                                              566

2.44.20.................. Items 46300 to 46534 apply only in certain circumstances 566

Subdivision H—Subgroup 15                                                                              573

2.44.21.................. Limitation of item 50303................................................. 573

Division 2.45—Group T9: Assistance at operations                                625

2.45.1.................... Meaning of amount under clause 2.45.1........................ 625

2.45.2.................... Meaning of amount under clause 2.45.2........................ 625

2.45.3.................... Meaning of amount under clause 2.45.3........................ 625

2.45.4.................... Meaning of previous significant surgical complication.. 625

2.45.5.................... Application of Group T9................................................ 626

2.45.6.................... Assistance at operations.................................................. 626

Division 2.46—Oral and Maxillofacial services                                         628

2.46.1.................... Application of Groups O1 to O11.................................. 628

Division 2.47—Group O1: Consultations                                                      629

Division 2.48—Group O2: Assistance at operation                                 630

2.48.1.................... Meaning of amount under clause 2.48.1........................ 630

2.48.2.................... Assistance at operations.................................................. 630

Division 2.49—Group O3: General surgery                                                632

Division 2.50—Group O4: Plastic and reconstructive                           639

2.50.1.................... Meaning of maxilla......................................................... 639

Division 2.51—Group O5: Preprosthetic                                                      644

Division 2.52—Group O6: Neurosurgical                                                     646

Division 2.53—Group O7: Ear, nose and throat                                       647

Division 2.54—Group O8: Temporomandibular joint                           649

Division 2.55—Group O9: Treatment of fractures                                  651

Division 2.56—Group O10: Diagnostic procedures and investigations                653

Division 2.57—Group O11: Regional or field nerve blocks                654

Part 3—Dictionary                                                                                                            655

Schedule 1A—Transitional provisions                                                668

Part 1      Amendments made by the Health Insurance Legislation Amendment (General Medical Services Table and Other Measures) Regulation 2014                                668

1............................ Medical practitioners in Prevocational General Practice Placements Program before 1 January 2015     668

Endnotes                                                                                                                                  669

Endnote 1—About the endnotes                                                                          669

Endnote 2—Abbreviation key                                                                              670

Endnote 3—Legislation history                                                                           671

Endnote 4—Amendment history                                                                         672

 


1  Name of regulation

                   This regulation is the Health Insurance (General Medical Services Table) Regulation 2014.

3  Authority

                   This regulation is made under the Health Insurance Act 1973.

4  Schedule(s)

                   Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

5  General medical services table

                   For subsection 4(1) of the Act, this regulation prescribes a table of medical services set out in Schedule 1.

6  Dictionary

                   The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this regulation, and includes references to certain words and expressions that are defined elsewhere in this regulation.

7  Transitional provisions

                   Schedule 1A contains provisions of a transitional nature.


Schedule 1General medical services table

Note:       See section 5.

Part 1Preliminary

Division 1.1Interpretation

1.1.1  Meaning of eligible non‑vocationally recognised medical practitioner

             (1)  In the table:

eligible non‑vocationally recognised medical practitioner means:

                     (a)  a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:

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

                             (ii)  is providing general medical services in accordance with that Program; or

                     (b)  a medical practitioner who:

                              (i)  is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and

                             (ii)  is providing general medical services in accordance with that Program; and

                            (iii)  is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:

                                        (A)  that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and

                                        (B)  of which the Chief Executive Medicare has written notice; or

                     (c)  a medical practitioner who:

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

                             (ii)  is providing general medical services in accordance with that Program; and

                            (iii)  is not vocationally registered under section 3F of the Act; or

                     (d)  a medical practitioner who:

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

                             (ii)  is providing general medical services in accordance with that Program; and

                            (iii)  is not vocationally registered under section 3F of the Act.

             (2)  In subclause (1):

After Hours Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

MedicarePlus for Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program means a program administered by the Department that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

Rural Other Medical Practitioners’ Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

1.1.1A  Meaning of general practitioner

                   In the table:

general practitioner means:

                     (a)  a practitioner who is vocationally registered under section 3F of the Act; or

                     (b)  a practitioner who:

                              (i)  is a Fellow of the RACGP; and

                             (ii)  participates in the quality assurance and continuing medical education program of the RACGP; and

                            (iii)  meets the RACGP requirements for quality assurance and continuing education; or

                     (c)  a practitioner in relation to whom a determination is in force under regulation 6DA of the Health Insurance Regulations 1975 recognising that he or she meets the fellowship standards of the ACRRM; or

                     (d)  a practitioner who is undertaking a placement in general practice that is approved by the RACGP:

                              (i)  as part of a training program for general practice leading to the award of Fellowship of the RACGP; or

                             (ii)  as part of another training program recognised by the RACGP as being of an equivalent standard; or

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

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

1.1.2  Meaning of multidisciplinary case conference

                   A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:

                     (a)  discussing a patient’s history;

                     (b)  identifying the patient’s multidisciplinary care needs;

                     (c)  identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;

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

                     (e)  assessing whether previously identified outcomes (if any) have been achieved.

1.1.3  Meaning of multidisciplinary case conference team

             (1)  A multidisciplinary case conference team for a patient:

                     (a)  includes a medical practitioner; and

                     (b)  either:

                              (i)  for items 735 to 758—includes at least 2 other members; or

                             (ii)  for an item mentioned in subclause (3)—includes at least 3 other members; and

                     (c)  may also include a family member of the patient.

             (2)  For the members mentioned in paragraph (b):

                     (a)  each member must provide a different kind of care or service to the patient; and

                     (b)  each member must not be a family carer of the patient; and

                     (c)  one member may be another medical practitioner.

Example:    Other members may be allied health professionals, home and community service providers and care organisers, including the following:

(a)    Aboriginal and Torres Strait Islander health practitioners;

(b)    asthma educators;

(c)    audiologists;

(d)    dental therapists;

(e)    dentists;

(f)    diabetes educators;

(g)    dieticians;

(h)    mental health workers;

(i)     occupational therapists;

(j)     optometrists;

(k)    orthoptists;

(l)     orthotists or prosthetists;

(m)   pharmacists;

(n)    physiotherapists;

(o)    podiatrists;

(p)    psychologists;

(q)    registered nurses;

(r)    social workers;

(s)    speech pathologists;

(t)     education providers;

(u)    “meals on wheels” providers;

(v)    personal care workers;

(w)   probation officers.

             (3)  For subparagraph (1)(b)(ii), the items are items 820, 822, 823, 830, 832, 834, 2946, 2949, 2954, 2978, 2984, 2988, 3032, 3040, 3044, 3069 and 3074.

1.1.4  Meaning of single course of treatment

             (1)  Use this clause for:

                     (a)  items 104 to 131, 133, 384 to 388, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6015, 16401, 16404, 16406, 51700 and 51703; and

                     (b)  the meaning of attendance in clause 1.1.1; and

                     (c)  the meaning of symbol (S) in clause 1.1.10; and

                     (d)  the definition of minor attendance in the Dictionary.

             (2)  A single course of treatment for a patient:

                     (a)  includes:

                              (i)  the initial attendance on the patient by a specialist or consultant physician; and

                             (ii)  the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and

                            (iii)  any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or by the specialist or consultant physician; but

                     (b)  does not include:

                              (i)  referral of the patient to the specialist or consultant physician; or

                             (ii)  an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under regulation 31 of the Health Insurance Regulations 1975 if:

                                        (A)  the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and

                                        (B)  the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.

1.1.5  Meaning of symbol (G)

                   An item including the symbol (G) applies only to a service not provided by a specialist in the practice of his or her specialty.

1.1.6  Meaning of symbol (H)

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

1.1.7  Meaning of symbol (S)

             (1)  An item including the symbol (S) applies only to a service performed by a specialist in the practice of his or her specialty, if:

                     (a)  the service is:

                              (i)  provided to a patient who has been referred to the specialist; and

                             (ii)  the first service performed by the specialist in accordance with the referral; or

                     (b)  the service is:

                              (i)  provided to a patient who has been referred to the specialist; and

                             (ii)  part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and

                            (iii)  provided within the period of validity of the referral that is applicable under regulation 31 of the Health Insurance Regulations 1975; or

                     (c)  the service is:

                              (i)  provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and

                             (ii)  the first service performed by the specialist in accordance with the referral; or

                     (d)  the service is:

                              (i)  provided to a patient who has not been referred to the specialist; and

                             (ii)  a service that, in an emergency, the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.

             (2)  In this clause:

emergency has the same meaning as in subregulation 30(5) of the Health Insurance Regulations 1975.

Division 1.2General application provisions

1.2.1  Application

                   An item in Part 2 does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.

1.2.2  Attendance by specialist or consultant physician

             (1)  Use this clause for items 99 to 137, 141 to 149, 288 to 389, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6016, 13210, 16399, 16401, 16404, 17609 and 17640 to 17655.

             (2)  An attendance on a patient by a specialist or consultant physician:

                     (a)  includes an attendance on a patient if:

                              (i)  the patient declares that a written referral of the patient was completed by a medical practitioner; or

                             (ii)  in an emergency, the patient has not been referred to the specialist, or consultant physician, if the specialist or consultant physician decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but

                     (b)  does not include an attendance on a patient if:

                              (i)  the attendance forms part of a single course of treatment for the patient in which the first service was provided to the patient more than 12 months (or another period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and

                             (ii)  a later referral has not been made.

             (3)  In this clause:

emergency has the same meaning as in subregulation 30(5) of the Health Insurance Regulations 1975.

1.2.3  Professional attendance services

             (1)  Use this clause for items 3 to 338, 348 to 389, 410 to 417, 501 to 600, 900, 903, 2497 to 2840, 3003, 3005 to 3028, 5000 to 5267, 6004, 6007 to 6016, 10905 to 10929, 13210, 16399, 16401, 16404, 16406, 16590, 16591 and 17609 to 17690.

             (2)  A professional attendance includes the provision, for a patient, of any of the following services:

                     (a)  evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the Act;

                     (b)  formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;

                     (c)  giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;

                     (d)  if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;

                     (e)  providing appropriate preventive health care;

                      (f)  recording the clinical details of the service or services provided to the patient.

             (3)  However, a professional attendance does not include the supply of a vaccine to a patient if:

                     (a)  the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 96 and 5000 to 5267; and

                     (b)  the cost of the vaccine is not subsidised by the Commonwealth or a State.

1.2.4  Personal attendance by medical practitioners generally

             (1)  Use this clause for items 3 to 149, 173 to 338, 348 to 536, 597 to 600, 2100 to 2220, 2497 to 2840, 3003, 3005 to 3028, 4001 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11724, 11921 to 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512 and 16515 to 51318.

             (2)  The item applies to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.

             (3)  A personal attendance by the medical practitioner on the patient includes any of the following:

                     (a)  a telepsychiatry consultation to which any of items 353 to 361 applies;

                     (b)  the planning, management and supervision of the patient on home dialysis to which item 13104 applies;

                     (c)  participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.

1.2.5  Personal attendance by medical practitioners

             (1)  Use this clause for items 3 to 723, 732, 900 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11722, 11724, 11820, 11823, 11921, 12000, 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512, 16515 to 51318.

             (2)  The item applies to a service provided during a personal attendance by:

                     (a)  a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or

                     (b)  a medical practitioner who:

                              (i)  is employed by the proprietor of a hospital that is not a private hospital; and

                             (ii)  provides the service otherwise than in the course of employment by that proprietor.

             (3)  Subclause (2) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

             (4)  A personal attendance by the medical practitioner on the patient includes any of the following:

                     (a)  a telepsychiatry consultation to which any of items 353 to 361 applies;

                     (b)  the planning, management and supervision of the patient on home dialysis to which item 13104 applies;

                     (c)  participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.

1.2.6  Consultant occupational physician

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

                     (a)  evaluating and assessing a patient’s rehabilitation requirements when, in the consultant’s opinion, the patient has an accepted medical condition that:

                              (i)  may be affected by the patient’s working environment; or

                             (ii)  affects the patient’s capacity to be employed;

                     (b)  managing an accepted medical condition that, in the consultant’s opinion, may affect a patient’s capacity for continued employment, or return to employment, following a non‑compensable accident, injury or ill‑health;

                     (c)  evaluating and forming an opinion about, including management as the case requires, a patient’s medical condition when causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.

1.2.7  Application of items—services provided with non‑medicare services

                   Items 3 to 10943 do not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.

1.2.7A  Application of items—services provided with autologous injections of blood or blood products

                   An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time, or in connection with, an injection of blood or a blood product that is autologous.

1.2.8  Services that may be provided by persons other than medical practitioners

             (1)  Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11222, 11224, 11225, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11700, 11702, 11708, 11709, 11710, 11711, 11712, 11713, 11715, 11718, 11721, 11727, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12015, 12018, 12021, 12200, 12203, 12207, 12210, 12213, 12215, 12217, 12250, 12500 to 12530, 13015, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.

             (2)  The item applies whether the medical service is given by:

                     (a)  a medical practitioner; or

                     (b)  a person, other than a medical practitioner, who:

                              (i)  is employed by a medical practitioner; or

                             (ii)  in accordance with accepted medical practice, acts under the supervision of a medical practitioner.

1.2.9  Meaning of participating in a video conferencing consultation

                   A medical practitioner is participating in a video conferencing consultation if the medical practitioner attends a patient who is receiving a service under an item in the table from a specialist or consultant physician who is providing the service:

                     (a)  in relation to his or her speciality to the patient; and

                     (b)  by way of a video conferencing consultation.

Part 2Services and fees

Division 2.1Groups A1 to A10

Note:       Groups A1 to A10 include Groups A1, A2, A3, A4, A28, A5, A6, A7, A8, A12, A13, A21, A11, A14, A15, A17, A18, A19, A20, A24, A27, A22, A23, A26, A9 and A10.

2.1.1  Meaning of amount under clause 2.1.1

                   In an item of the table mentioned in column 1 of table 2.1.1:

amount under clause 2.1.1 means the sum of:

                     (a)  the fee mentioned in column 2 for the item; and

                     (b)  either:

                              (i)  if a practitioner attends not more than 6 patients in a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

                             (ii)  if a practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 4 for the item.

 

Table 2.1.1—Amount under clause 2.1.1

Item

Column 1

Item/s of the table

Column 2

Fee

Column 3

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

Column 4

Amount if more than 6 patients ($)

1

4

The fee for item 3

25.95

2.00

2

20

The fee for item 3

46.70

3.30

3

24

The fee for item 23

25.95

2.00

4

35

The fee for item 23

46.70

3.30

5

37

The fee for item 36

25.95

2.00

6

43

The fee for item 36

46.70

3.30

7

47

The fee for item 44

25.95

2.00

8

51

The fee for item 44

46.70

3.30

9

58

$8.50

15.50

0.70

10

59, 2610, 2631, 2673

$16.00

17.50

0.70

11

60, 2613, 2633, 2675

$35.50

15.50

0.70

12

65, 2616, 2635, 2677

$57.50

15.50

0.70

13

92

$8.50

27.95

1.25

14

93

$16.00

31.55

1.25

15

95

$35.50

27.95

1.25

16

96

$57.50

27.95

1.25

17

195

The fee for item 193

25.95

2.00

18

414

The fee for item 410

25.45

1.95

19

415

The fee for item 411

25.45

1.95

20

416

The fee for item 412

25.45

1.95

21

417

The fee for item 413

25.45

1.95

22

2503

The fee for item 2501

25.95

2.00

23

2506

The fee for item 2504

25.95

2.00

24

2509

The fee for item 2507

25.95

2.00

25

2518

The fee for item 2517

25.95

2.00

26

2522

The fee for item 2521

25.95

2.00

27

2526

The fee for item 2525

25.95

2.00

28

2547

The fee for item 2546

25.95

2.00

29

2553

The fee for item 2552

25.95

2.00

30

2559

The fee for item 2558

25.95

2.00

31

5003

The fee for item 5000

25.95

2.00

32

5010

The fee for item 5000

46.70

3.30

33

5023

The fee for item 5020

25.95

2.00

34

5028

The fee for item 5020

46.70

3.30

35

5043

The fee for item 5040

25.95

2.00

36

5049

The fee for item 5040

46.70

3.30

37

5063

The fee for item 5060

25.95

2.00

38

5067

The fee for item 5060

46.70

3.30

39

5220

$18.50

15.50

0.70

40

5223

$26.00

17.50

0.70

41

5227

$45.50

15.50

0.70

42

5228

$67.50

15.50

0.70

43

5260

$18.50

27.95

1.25

44

5263

$26.00

31.55

1.25

45

5265

$45.50

27.95

1.25

46

5267

$67.50

27.95

1.25

Division 2.2Group A1: General practitioner attendances to which no other item applies

 

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

Item

Description

Fee ($)

3

Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—each attendance

16.95

4

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies) that requires a short patient history and, if necessary, limited examination and management—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

20

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

23

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

37.05

24

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

35

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

36

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

71.70

37

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

43

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

44

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

105.55

47

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

51

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

Division 2.3Group A2: Other non‑referred attendances to which no other item applies

2.3.1  Effect of determination under section 106TA of Act

             (1)  This clause applies to a general practitioner, if:

                     (a)  the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and

                     (b)  the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and

                     (c)  the determination states that the practitioner is disqualified for a service mentioned in an item in Group A1; and

                     (d)  the practitioner provides a service mentioned in an item in Group A2.

             (2)  The determination applies to the service mentioned in paragraph (1)(d).

 

Group A2—Other non‑referred attendances to which no other item applies

Item

Description

Fee ($)

52

Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

11.00

53

Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

21.00

54

Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

38.00

57

Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

61.00

58

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies), not more than 5 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

59

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

60

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

65

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 45 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

92

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of not more than 5 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

93

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

95

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

96

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 45 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

Division 2.4Group A3: Specialist attendances to which no other item applies

2.4.1  Limitation of item 99

                   Item 99 does not apply if the patient or the specialist
travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.

 

Group A3—Specialist attendances to which no other item applies

Item

Description

Fee ($)

99

Professional attendance on a patient by a specialist practising in his or her specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 104 lasting more than 10 minutes; or

(ii) provided with item 105; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 104 or 105

104

Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty after referral of the patient to him or her—each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

85.55

105

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital

43.00

106

Professional attendance by a specialist in the practice of his or her specialty of ophthalmology and following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses, if that attendance is at consulting rooms or hospital (other than a service to which any of items 104, 109 and 10801 to 10816 applies)

71.00

107

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment), if that attendance is at a place other than consulting rooms or hospital

125.50

108

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—each attendance after the first in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital

79.45

109

Professional attendance by a specialist in the practice of his or her specialty of ophthalmology following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which a comprehensive eye examination, including pupil dilation, is performed on:

(a) a patient aged 9 years or younger; or

(b) a patient aged 14 years or younger with developmental delay;

(other than a service to which any of items 104, 106 and 10801 to 10816 applies)

192.80

113

Initial professional attendance of 10 minutes or less in duration on a patient by a specialist in the practice of his or her speciality if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

64.20

Division 2.5Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies

2.5.1  Limitation of items 112 to 114

                   Items 112, 113 and 114 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:

                     (a)  for item 112—sub‑subparagraph (d)(i)(B) of the item; and

                     (b)  for items 113 and 114—sub‑subparagraph (c)(i)(B) of the item.

 

Group A4—Consultant physician attendances to which no other item applies

Item

Description

Fee ($)

110

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

150.90

112

Professional attendance on a patient by a consultant physician practising in his or her specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 110 lasting more than 10 minutes; or

(ii) provided with item 116, 119, 132 or 133; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

50% of the fee for item 110, 116, 119, 132 or 133

 

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

 

114

Initial professional attendance of 10 minutes or less in duration on a patient by a consultant physician practising in his or her specialty if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

113.20

116

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 119 applies) after the first in a single course of treatment

75.50

119

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment

43.00

122

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

183.10

128

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 131 applies) after the first in a single course of treatment

110.75

131

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment

79.75

132

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

(a) an assessment is undertaken that covers:

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

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

(iii) the formulation of differential diagnoses; and

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

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

(ii) treatment options and decisions; and

(iii) medication recommendations; and

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

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

263.90

133

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

(a) a review is undertaken that covers:

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

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

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

(iv) review of original and differential diagnoses; and

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

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

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

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

(d) item 132 applied to an attendance claimed in the preceding 12 months; and

(e)  the attendance under this item is claimed by the same consultant physician who claimed item 132 or a locum tenens; and

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

132.10

Division 2.5AGroup A29: Early intervention services for children with autism, pervasive developmental disorder or disability

2.5A.1  Meanings of eligible allied health provider and risk assessment

                   In items 135, 137 and 139:

eligible allied health provider means any of the following:

                     (a)  an audiologist;

                     (b)  an occupational therapist;

                     (c)  a participating optometrist;

                     (d)  an orthoptist;

                     (e)  a physiotherapist;

                      (f)  a psychologist;

                     (g)  a speech pathologist.

risk assessment means an assessment of:

                     (a)  the risk to the patient of a contributing co‑morbidity; and

                     (b)  environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.

2.5A.2  Meaning of eligible disability

                   An 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 4 frequencies; or

                             (ii)  permanent conductive hearing loss and auditory neuropathy;

                     (c)  deafblindness;

                     (d)  cerebral palsy;

                     (e)  Down syndrome;

                      (f)  Fragile X syndrome;

                     (g)  Prader‑Willi syndrome;

                     (h)  Williams syndrome;

                      (i)  Angelman syndrome;

                      (j)  Kabuki syndrome;

                     (k)  Smith‑Magenis syndrome;

                      (l)  CHARGE syndrome;

                    (m)  Cri du Chat syndrome;

                     (n)  Cornelia de Lange syndrome;

                     (o)  microcephaly, if a child has:

                              (i)  a head circumference less than the third percentile for age and sex; and

                             (ii)  a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence;

                     (p)  Rett’s disorder.

 

Group A29—Early intervention services for children with autism, pervasive developmental disorder or disability

Item

Description

Fee ($)

135

Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of paediatrics, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or another pervasive developmental disorder, if the consultant paediatrician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medical recommendations;

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 137, 139 or 289)

263.90

137

Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a specialist or consultant physician (not including a general practitioner) following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the specialist or consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 139 or 289)

263.90

139

Professional attendance of at least 45 minutes in duration at consulting rooms only, by a general practitioner (not including a specialist or consultant physician) for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the general practitioner does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 289)

132.50

Division 2.6Group A28: Geriatric medicine

2.6.1  Limitation of item 149

                   Item 149 does not apply if the patient, physician or
specialist travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.

 

Group A28—Geriatric medicine

Item

Description

Fee ($)

141

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

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

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

(c) during the attendance:

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

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

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

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

(B) short and longer term management goals; and

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

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

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

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

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

452.65

143

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

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

(b) during the attendance:

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

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

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

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

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

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

282.95

145

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

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

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

(c) during the attendance:

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

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

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

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

(B) short and longer term management goals; and

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

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

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

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

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

548.85

147

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

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

(b) during the attendance:

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

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

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

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

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

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

343.10

149

Professional attendance on a patient by a consultant physician or specialist practising in his or her specialty of geriatric medicine if:

(a) the attendance is by video conference; and

(b) item 141 or 143 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician or specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

      for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 141 or 143

Division 2.7Group A5: Prolonged attendances to which no other item applies

2.7.1  Application of items 160 to 164

             (1)  Items 160 to 164 apply only to a service provided in the course of a personal attendance by one or more medical practitioners on a single patient on a single occasion.

             (2)  If the personal attendance is provided by one or more medical practitioners concurrently, each practitioner may claim an attendance fee.

             (3)  However, if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance.

 

Group A5—Prolonged attendances to which no other item applies

Item

Description

Fee ($)

160

Professional attendance for a period of not less than 1 hour but less than 2 hours (other than a service to which another item applies) on a patient in imminent danger of death

221.50

161

Professional attendance for a period of not less than 2 hours but less than 3 hours (other than a service to which another item applies) on a patient in imminent danger of death

369.15

162

Professional attendance for a period of not less than 3 hours but less than 4 hours (other than a service to which another item applies) on a patient in imminent danger of death

516.65

163

Professional attendance for a period of not less than 4 hours but less than 5 hours (other than a service to which another item applies) on a patient in imminent danger of death

664.55

164

Professional attendance for a period of 5 hours or more (other than a service to which another item applies) on a patient in imminent danger of death

738.40

Division 2.8Group A6: Group therapy

 

Group A6—Group therapy

Item

Description

Fee ($)

170

Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 2 patients

117.55

171

Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 3 patients

123.85

172

Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 4 or more patients

150.70

Division 2.9Group A7: Acupuncture

2.9.1  Meaning of qualified medical acupuncturist

                   A general practitioner is a qualified medical acupuncturist, for an item, if the Chief Executive Medicare has received a written notice from the Royal Australian College of General Practitioners stating that the general practitioner meets the skills requirements for providing the service described in the item.

 

Group A7—Acupuncture

Item

Description

Fee ($)

173

Professional attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture was performed

21.65

193

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

37.05

195

Professional attendance by a general practitioner who is a qualified medical acupuncturist, on one or more patients at a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Amount under clause 2.1.1

197

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

71.70

199

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

105.55

Division 2.10Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies

2.10.1  Application of items 291, 293 and 359

                   Items 291, 293 and 359 may only apply once in a 12 month period.

2.10.2  Application of items 342, 344 and 346

                   Items 342, 344 and 346 apply only to a service provided in the course of a personal attendance by a single medical practitioner.

2.10.3  Restriction of telepsychiatry consultations to regional, rural and remote areas

                   Items 353 to 361 apply only to a consultation that is provided to a patient in a regional, rural or remote area.

2.10.4  Limitation of item 288

                   Item 288 does not apply if the patient or physician travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.

2.10.5  Meanings of eligible allied health provider and risk assessment

                   In item 289:

eligible allied health provider means any of the following:

                     (a)  an audiologist;

                     (b)  an occupational therapist;

                     (c)  a participating optometrist;

                     (d)  an orthoptist;

                     (e)  a physiotherapist;

                      (f)  a psychologist;

                     (g)  a speech pathologist.

risk assessment means an assessment of:

                     (a)  the risk to the patient of a contributing co‑morbidity; and

                     (b)  environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.

 

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

Item

Description

Fee ($)

288

Professional attendance on a patient by a consultant physician practising in his or her specialty of psychiatry if:

(a) the attendance is by video conference; and

(b) item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352

289

Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with autism or another pervasive developmental disorder, if the consultant psychiatrist does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to the referring practitioner;

(d) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 139)

263.90

291

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

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

(b) during the attendance, the consultant:

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

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

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

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

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

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

(A) covers the next 12 months; and

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

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

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

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

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

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

(A) the patient; and

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

452.65

293

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

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

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

(c) during the attendance, the consultant:

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

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

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

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

(ii) revises the management plan; and

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

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

(A) the patient; and

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

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

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

282.95

296

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

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

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

other than attendance on a patient in relation to whom this item, item 297 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months

260.30

297

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

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

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

other than attendance on a patient in relation to whom this item, item 296 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months (H)

260.30

299

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

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

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

other than attendance on a patient in relation to whom this item, item 296 or 297, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months

311.30

300

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

43.35

302

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

86.45

304

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

133.10

306

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

183.65

308

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

213.15

310

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

21.60

312

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

43.35

314

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

66.65

316

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

91.95

318

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

106.60

319

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

(a) been diagnosed as suffering severe personality disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, substance‑related disorder, somatoform disorder or a pervasive development disorder; and

(b) for persons 18 years and over—been rated with a level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning Scale;

if that attendance and another attendance to which any of items 296, 300 to 319, 353 to 358 and 361 to 370 applies have not exceeded 160 attendances in a calendar year for the patient

183.65

320

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration at hospital

43.35

322

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration at hospital

86.45

324

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration at hospital

133.10

326

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration at hospital

183.65

328

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration at hospital

213.15

330

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration if that attendance is at a place other than consulting rooms or hospital

79.55

332

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration if that attendance is at a place other than consulting rooms or hospital

124.65

334

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration if that attendance is at a place other than consulting rooms or hospital

181.65

336

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration if that attendance is at a place other than consulting rooms or hospital

219.75

338

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration if that attendance is at a place other than consulting rooms or hospital

249.55

342

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which Group therapy is conducted) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a Group of 2 to 9 unrelated patients or a family Group of more than 3 patients, each of whom is referred to the consultant physician by a referring practitioner—each patient

49.30

344

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which Group therapy is conducted) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a family Group of 3 patients, each of whom is referred to the consultant physician by a referring practitioner—each patient

65.45

346

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which Group therapy is conducted) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a family Group of 2 patients, each of whom is referred to the consultant physician by a referring practitioner—each patient

96.80

348

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes, but less than 45 minutes, in duration, in the course of initial diagnostic evaluation of a patient

126.75

350

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 45 minutes in duration, in the course of initial diagnostic evaluation of a patient

175.00

352

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes in duration, in the course of continuing management of a patient—if that attendance and another attendance to which this item applies have not exceeded 4 in a calendar year for the patient

126.75

353

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of not more than 15 minutes in duration, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

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

57.20

355

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 15 minutes, but not more than 30 minutes, in duration, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

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

114.45

356

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

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

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

167.80

357

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 45 minutes, but not more than 75 minutes, in duration, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

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

231.45

358

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 75 minutes in duration, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

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

282.00

359

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

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

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

(c) during the attendance, the consultant:

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

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

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

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

(ii) revises the management plan; and

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

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

(A) the patient; and

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

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

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

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

325.35

361

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 45 minutes in duration, if the patient:

(a) either:

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

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

(b) is located in a regional, rural or remote area;

other than attendance on a patient in relation to whom this item, item 296, 297 or 299, or any of items 300 to 346 and 353 to 370, has applied in the preceding 24 month period

299.30

364

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of not more than 15 minutes in duration, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

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

43.35

366

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 15 minutes, but not more than 30 minutes, in duration, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

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

86.45

367

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 30 minutes, but not more than 45 minutes, in duration, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

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

133.10

369

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 45 minutes, but not more than 75 minutes, in duration, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

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

183.80

370

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 75 minutes in duration, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

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

213.15

Division 2.11Group A12: Consultant occupational physician attendances to which no other item applies

2.11.1  Limitation of items 384 and 389

                   Items 384 and 389 do not apply if the patient or physician travels to a place to satisfy the requirement in:

                     (a)  for item 384—sub‑subparagraph (c)(i)(B) of the item; and

                     (b)  for item 389—sub‑subparagraph (d)(i)(B) of the item.

 

Group A12—Consultant occupational physician attendances to which no other item applies

Item

Description

Fee ($)

384

Initial professional attendance of 10 minutes or less in duration on a patient by a consultant occupational physician practising in his or her specialty of occupational medicine if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

64.20

385

Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

85.55

386

Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—each attendance after the first in a single course of treatment

43.00

387

Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

125.50

388

Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—each attendance after the first in a single course of treatment

79.45

389

Professional attendance on a patient by a consultant occupational physician practising in his or her specialty of occupational medicine if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 385 lasting more than 10 minutes; or

(ii) provided with item 386; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

50% of the fee for item 385 or 386

 

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

 

Division 2.12Group A13: Public health physician attendances to which no other item applies

2.12.1  Public health physicians

                   Items 410 to 417 apply to an attendance on a patient by a public health physician only if the attendance relates to one or more of the following matters:

                     (a)  management of a patient’s vaccination requirements for immunisation programs;

                     (b)  prevention or management of sexually transmitted disease;

                     (c)  prevention or management of disease caused by scientifically accepted environmental hazards or toxins;

                     (d)  prevention or management of infection arising from an outbreak of an infectious disease;

                     (e)  prevention or management of an exotic disease.

Note:          An exotic disease is medically accepted as a disease that is of foreign origin.

 

Group A13—Public health physician attendances to which no other item applies

Item

Description

Fee ($)

410

Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine—attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

19.55

411

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

42.75

412

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

82.65

413

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

121.70

414

Professional attendance at other than consulting rooms by a public health physician in the practice of his or her specialty of public health medicine—attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

Amount under clause 2.1.1

415

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

Amount under clause 2.1.1

416

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

Amount under clause 2.1.1

417

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

Amount under clause 2.1.1

Division 2.13Miscellaneous services

Note:       Reserved for future use.

Division 2.14Group A21: Emergency physician attendances to which no other item applies

2.14.1  Meaning of recognised emergency department

                   In this Division:

recognised emergency department, of a private hospital, means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.

2.14.2  Meaning of problem focussed history

                   In items 501, 503 and 507:

problem focussed history, for a patient, means a history focussing on the medical condition of the patient that necessitates the patient presenting for emergency attention.

2.14.3  Attendance for emergency evaluation of critically ill patients

                   In items 519 to 536, an attendance, for an emergency evaluation of a critically ill patient with an immediately life threatening problem, is an attendance that requires:

                     (a)  immediate and rapid assessment; and

                     (b)  initiation of resuscitation and electronic monitoring of vital signs; and

                     (c)  taking a comprehensive history and evaluation while undertaking resuscitative measures; and

                     (d)  ordering and evaluation of appropriate investigations; and

                     (e)  transitional evaluation and monitoring; and

                      (f)  formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

                     (g)  initiation of appropriate treatment interventions; and

                     (h)  liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent.

 

Group A21—Emergency physician attendances to which no other item applies

Item

Description

Fee ($)

501

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving straightforward medical decision making that requires:

(a) taking a problem focussed history; and

(b) limited examination; and

(c) diagnosis; and

(d) initiation of appropriate treatment interventions

34.20

503

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of low complexity that requires:

(a) taking an expanded problem focussed history; and

(b) expanded examination of one or more systems; and

(c) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(d) initiation of appropriate treatment interventions

57.80

507

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires:

(a) taking an expanded problem focussed history; and

(b) expanded examination of one or more systems; and

(c) ordering and evaluation of appropriate investigations; and

(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(e) initiation of appropriate treatment interventions

97.05

511

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires:

(a) taking a detailed history; and

(b) detailed examination of one or more systems; and

(c) ordering and evaluation of appropriate investigations; and

(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(e) initiation of appropriate treatment interventions; and

(f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent

137.30

515

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of high complexity that requires:

(a) taking a comprehensive history; and

(b) comprehensive examination of one or more systems; and

(c) ordering and evaluation of appropriate investigations; and

(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(e) initiation of appropriate treatment interventions; and

(f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent

212.60

519

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 30 minutes but less than 1 hour (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem

146.20

520

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 1 hour but less than 2 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem

280.85

530

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 2 hours but less than 3 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem

460.30

532

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 3 hours but less than 4 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem

639.75

534

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 4 hours but less than 5 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem

819.35

536

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 5 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem

909.10

Division 2.15Group A11: Urgent attendances after hours

2.15.1  Meaning of patient’s medical condition requires urgent treatment

             (1)  For items 597 to 600, a patient’s medical condition requires urgent treatment if:

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

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

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

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

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

2.15.2  Meaning of responsible person

                   For items 597 to 600, a responsible person, for a patient:

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

                     (b)  does not include:

                              (i)  the attending medical practitioner; or

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

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

                            (iv)  a call centre; or

                             (v)  a reception service.

2.15.3  Application of Group A11

                   Items 597 to 600 do not apply to a service provided by a medical practitioner if:

                     (a)  the service is provided at consulting rooms; and

                     (b)  the practitioner:

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

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

2.15.4  Effect of determination under section 106TA of Act

             (1)  This clause applies to a general practitioner if:

                     (a)  the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and

                     (b)  the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and

                     (c)  the determination specifies the practitioner is disqualified in relation to a service mentioned in an item in Group A1; and

                     (d)  the practitioner provides a service mentioned in item 598 or 600.

             (2)  The determination applies to the service mentioned in paragraph (1)(d).

 

Group A11—Urgent attendances after hours

Item

Description

Fee ($)

597

Professional attendance by a general practitioner on not more than one patient on one occasion—each attendance (other than an attendance in unsociable hours) in an after‑hours period if:

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

(b) if the attendance is performed at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

129.80

598

Professional attendance by a medical practitioner (other than a general practitioner), or a general practitioner to whom clause 2.15.4 applies, on not more than one patient on one occasion—each attendance (other than an attendance in unsociable hours) in an after‑hours period if:

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

(b) if the attendance is at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

104.75

599

Professional attendance by a general practitioner on not more than one patient on one occasion—each attendance in unsociable hours if:

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

(b) if the attendance is at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

153.00

600

Professional attendance by a medical practitioner (other than a general practitioner), or a general practitioner to whom clause 2.15.4 applies, on not more than one patient on one occasion—each attendance in unsociable hours if:

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

(b) if the attendance is at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

124.25

Division 2.16Group A14: Health assessments

2.16.1  Application of Group A14

                   Items 701 to 715 apply only to a service provided in the course of a personal attendance by a single medical practitioner on a single patient.

2.16.2  Types of health assessments

             (1)  The following health assessments may be performed under item 701, 703, 705 or 707:

                     (a)  a Healthy Kids Check, in accordance with clause 2.16.4, for a patient who is:

                              (i)  at least 3 years old and under 5 years old; and

                             (ii)  receiving or has received the immunisation recommended for a 4 year old child; and

                            (iii)  not an in‑patient of a hospital;

                     (b)  a Type 2 Diabetes Risk Evaluation, in accordance with clause 2.16.5, for a patient who:

                              (i)  is at least 40 years old and under 50 years old; and

                             (ii)  has a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool; and

                            (iii)  is not an in‑patient of a hospital;

                     (c)  a 45 year old Health Assessment, in accordance with clause 2.16.6, for a patient who is:

                              (i)  at least 45 years old and under 50 years old; and

                             (ii)  at risk of developing a chronic disease; and

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

                     (d)  an Older Person’s Health Assessment, in accordance with clause 2.16.7, for a patient who is:

                              (i)  at least 75 years old; and

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

                     (e)  a Comprehensive Medical Assessment, in accordance with clause 2.16.8, for a patient who is a permanent resident of a residential aged care facility;

                      (f)  a health assessment, in accordance with clause 2.16.9, for a person with an intellectual disability, if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility;

                     (g)  a health assessment, in accordance with clause 2.16.10, for a patient who:

                              (i)  is a refugee or humanitarian entrant, with eligibility for Medicare; and

                             (ii)  either:

                                        (A)  holds a relevant visa that the person has held for less than 12 months at the time of the assessment; or

                                        (B)  first entered Australia less than 12 months before the assessment is performed; and

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

                     (h)  an Australian Defence Force Post‑discharge GP Health Assessment, in accordance with clause 2.16.10A, for a patient who:

                              (i)  is a former member of the Permanent Forces (within the meaning of the Defence Act 1903) or a former member of the Reserves (within the meaning of that Act); and

                             (ii)  has not already received such an assessment.

Note:          The Australian Type 2 Diabetes Risk Assessment Tool could in 2014 be viewed on the Department’s website (http://www.health.gov.au).

             (2)  In this clause:

relevant visa means any of the following visas granted under the Migration Act 1958:

                     (a)  Subclass 070 Bridging (Removal Pending) visa;

                     (b)  Subclass 200 (Refugee) visa;

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

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

                     (e)  Subclass 203 (Emergency Rescue) visa;

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

                     (g)  Subclass 695 (Return Pending) visa;

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

                      (i)  Subclass 866 (Protection) visa.

2.16.3  Application of item 715 to certain patients only

             (1)  The following health assessments may be performed under item 715:

                     (a)  an Aboriginal and Torres Strait Islander child health assessment, in accordance with clause 2.16.11, for a patient if the patient is:

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

                             (ii)  under 15 years old; and

                            (iii)  not an in‑patient of a hospital;

                     (b)  an Aboriginal and Torres Strait Islander adult health assessment, in accordance with clause 2.16.12, for a patient if the patient is:

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

                             (ii)  at least 15 years old and under 55 years old; and

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

                     (c)  an Aboriginal and Torres Strait Islander Older Person’s Health Assessment, in accordance with clause 2.16.13, for a patient if the patient is:

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

                             (ii)  at least 55 years old; and

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

             (2)  For this clause and item 715, a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.

2.16.4  Healthy Kids Check

             (1)  A Healthy Kids Check is the assessment of:

                     (a)  a patient’s physical health, general wellbeing and development; and

                     (b)  whether any medical intervention is required for the patient.

             (2)  The following may perform a Healthy Kids Check:

                     (a)  a medical practitioner (including a general practitioner);

                     (b)  a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf, and under the supervision, of a medical practitioner.

             (3)  If a practice nurse or a registered Aboriginal and Torres Strait Islander health practitioner performs a Healthy Kids Check for a patient and identifies any problems, the patient must be reviewed by the patient’s usual medical practitioner, who must arrange referrals and follow‑up services as required.

             (4)  A Healthy Kids Check for a patient must include the following basic physical examinations and assessments:

                     (a)  measurement of the patient’s height and weight to calculate the patient’s body mass index and position on the growth curve;

                     (b)  eyesight;

                     (c)  hearing;

                     (d)  oral health (teeth and gums);

                     (e)  toileting;

                      (f)  allergies.

             (5)  A Healthy Kids Check for a patient must also include:

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

                     (b)  making an overall assessment of the patient; and

                     (c)  initiating interventions or referrals, as appropriate; and

                     (d)  giving health advice and information to the patient’s parent or carer, using the guide called Get Set 4 Life—habits for healthy kids.

Note:          The Get Set 4 Life—habits for healthy kids guide could in 2014 be viewed on the Department’s website (http://www.health.gov.au).

             (6)  The person performing a Healthy Kids Check must:

                     (a)  note if a copy of the guide mentioned in paragraph (5)(d) has been given to the patient’s parent or carer; and

                     (b)  record evidence that the immunisation recommended for a 4 year old child has been given to the patient.

             (7)  The immunisation recommended for a 4 year old child may be given to a patient when he or she has a Healthy Kids Check, and may be claimed separately.

             (8)  The Healthy Kids Check must not be provided more than once to an eligible person.

2.16.5  Type 2 Diabetes Risk Evaluation

             (1)  A Type 2 Diabetes Risk Evaluation must include:

                     (a)  a review of the risk factors underlying a patient’s high risk score as identified by the Australian Type 2 Diabetes Risk Assessment Tool; and

                     (b)  initiating interventions, if appropriate, to address risk factors or to exclude diabetes.

Note:          The Australian Type 2 Diabetes Risk Assessment Tool could in 2014 be viewed on the Department’s website (http://www.health.gov.au).

             (2)  The Type 2 Diabetes Risk Evaluation for a patient must also include:

                     (a)  assessing the patient’s high risk score as determined by the Australian Type 2 Diabetes Risk Assessment Tool (to be completed by the patient within 3 months before performing the Type 2 Diabetes Risk Evaluation); and

                     (b)  updating the patient’s history and performing physical examinations and clinical investigations; and

Note:          Guidelines for examination and assessment include the Royal Australian College of General Practitioners publications Putting Prevention into Practice and Guidelines for Preventive Activities in General Practice. These documents could in 2014 be viewed on the Royal Australian College of General Practitioners’ website (http://www.racgp.org.au).

                     (c)  making an overall assessment of the patient’s risk factors and the results of examinations and investigations; and

                     (d)  initiating interventions, if appropriate, including referrals and follow‑up services relating to the management of any risk factors identified; and

                     (e)  giving the patient advice and information, including strategies to achieve lifestyle and behaviour changes if appropriate.

             (3)  A Type 2 Diabetes Risk Evaluation must not be provided more than once every 3 years to an eligible person.

             (4)  For this clause, risk factors includes:

                     (a)  lifestyle risk factors (for example smoking, physical inactivity or poor nutrition); and

                     (b)  biomedical risk factors (for example high blood pressure, impaired glucose metabolism or excess weight); and

                     (c)  a family history of a chronic disease.

2.16.6  45 year old Health Assessment

             (1)  A 45 year old Health Assessment is an assessment for a patient if the patient, in the clinical judgment of the attending medical practitioner based on the identification of a specific risk factor, is at risk of developing a chronic disease.

             (2)  The 45 year old Health Assessment must include:

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

                     (b)  making an overall assessment of the patient; and

                     (c)  initiating interventions or referrals, as appropriate; and

                     (d)  giving health advice and information to the patient.

             (3)  The medical practitioner providing the assessment is responsible for the overall health assessment of the patient.

             (4)  A 45 year old Health Assessment must not be given more than once to an eligible person.

             (5)  In this clause:

chronic disease means a disease that has been, or is likely to be, present for at least 6 months, including asthma, cancer, cardiovascular illness, diabetes mellitus, a mental health condition, arthritis or a musculoskeletal condition.

specific risk factors includes:

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

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

                     (c)  a family history of a chronic disease.

2.16.7  Older Person’s Health Assessment

             (1)  An Older Person’s Health Assessment is the assessment of:

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

                     (b)  whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.

             (2)  An Older Person’s Health Assessment must include:

                     (a)  personal attendance by a medical practitioner; and

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

                     (c)  assessment of the patient’s medication; and

                     (d)  assessment of the patient’s continence; and

                     (e)  assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and

                      (f)  assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months; and

                     (g)  assessment of the patient’s psychological function, including the patient’s cognition and mood; and

                     (h)  assessment of the patient’s social function, including:

                              (i)  the availability and adequacy of paid, and unpaid, help; and

                             (ii)  whether the patient is responsible for caring for another person.

             (3)  An Older Person’s Health Assessment must also include:

                     (a)  keeping a record of the health assessment; and

                     (b)  offering the patient a written report on the health assessment, with recommendations about matters covered by the health assessment; and

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

             (4)  An Older Person’s Health Assessment must not be provided more than once every 12 months to an eligible person.

2.16.8  Comprehensive Medical Assessment for permanent resident of residential aged care facility

             (1)  A Comprehensive Medical Assessment of a permanent resident of a residential aged care facility includes an assessment of the resident’s health and physical and psychological function.

             (2)  A Comprehensive Medical Assessment must include:

                     (a)  a personal attendance by a medical practitioner; and

                     (b)  taking a detailed patient history of the resident; and

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

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

                     (e)  giving a written copy of a summary of the outcomes of the assessment to the residential aged care facility for the resident’s medical records.

             (3)  A Comprehensive Medical Assessment must also include:

                     (a)  making a written summary of the Comprehensive Medical Assessment; and

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

                     (c)  offering the resident a copy of the summary.

             (4)  A Comprehensive Medical Assessment may be provided:

                     (a)  on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided in another residential aged care facility in the last 12 months; and

                     (b)  at 12 month intervals after that assessment.

             (5)  A Comprehensive Medical Assessment may be performed in conjunction with a consultation for another purpose, but must be claimed separately.

2.16.9  Health assessment for a person with an intellectual disability

             (1)  A health assessment for a person with an intellectual disability is an assessment of:

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

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

             (2)  The health assessment for a person with an intellectual disability must include the following matters to the extent that they are relevant to the patient:

                     (a)  checking dental health (including dentition);

                     (b)  conducting an aural examination (including arranging a formal audiometry if an audiometry has not been conducted within the last 5 years);

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

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

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

                      (f)  assessing medications including:

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

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

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

                     (g)  checking immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps, rubella and pneumococcal vaccinations) with reference to the Australian Immunisation Handbook, for appropriate vaccination schedules;

Note:          The Australian Immunisation Handbook could in 2014 be viewed on the Department’s website (http://www.health.gov.au).

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

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

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

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

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

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

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

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

                     (p)  assessing or reviewing treatment for co‑morbid mental health issues;

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

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

             (3)  A health assessment for a person with an intellectual disability must also include:

                     (a)  keeping a record of the health assessment; and

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

                     (c)  offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report; and

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

             (4)  A health assessment for a person with an intellectual disability must not be provided more than once every 12 months to an eligible person.

2.16.10  Health assessment for a refugee or other humanitarian entrant

             (1)  A health assessment for a refugee or other humanitarian entrant is the assessment of:

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

                     (b)  whether preventive health care and education should be offered to the patient to improve their health and physical, psychological or social function.

             (2)  A health assessment for a refugee or other humanitarian entrant must include:

                     (a)  a personal attendance by a medical practitioner; and

                     (b)  taking the patient’s history; and

                     (c)  examining the patient; and

                     (d)  performing or arranging any required investigations; and

                     (e)  assessing the patient, using the information gained in paragraphs (b), (c) and (d); and

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

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

             (3)  A health assessment for a refugee or other humanitarian entrant must also include:

                     (a)  keeping a record of the health assessment; and

                     (b)  offering to provide the patient with a written report of the health assessment.

             (4)  A health assessment for a refugee or other humanitarian entrant must not be provided to a patient more than once.

2.16.10A  Australian Defence Force Post‑discharge GP Health Assessment

             (1)  An Australian Defence Force Post‑discharge GP Health Assessment is an assessment of:

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

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

             (2)  The assessment must be performed by the patient’s usual doctor.

             (3)  The assessment must not be performed in conjunction with a separate consultation in relation to the patient unless the consultation is clinically necessary.

             (4)  The assessment may be performed using the ADF Post‑discharge GP Health Assessment Tool.

Note 1:       The ADF Post‑discharge GP Health Assessment Tool could in 2014 be viewed on the Department of Veterans’ Affairs’ At Ease website (http://at‑ease.dva.gov.au).

Note 2:       Other assessment tools mentioned in the Department of Veterans’ Affairs Mental Health Advice Book may be relevant. The Mental Health Advice Book could in 2014 be viewed on the Department of Veterans’ Affairs’ At Ease website (http://at‑ease.dva.gov.au).

             (5)  The assessment must include taking a history of the patient that includes the following:

                     (a)  the patient’s service with the Australian Defence Force, including service type, years of service, field of work, number of deployments and reason for discharge;

                     (b)  the patient’s social history, including relationship status, number of children (if any) and current occupation;

                     (c)  the patient’s current medical conditions;

                     (d)  whether the patient suffers from hearing loss or tinnitus;

                     (e)  the patient’s use of medication, including medication prescribed by another doctor and medication obtained without a prescription;

                      (f)  the patient’s smoking, if applicable;

                     (g)  the patient’s alcohol use, if applicable;

                     (h)  the patient’s substance use, if applicable;

                      (i)  the patient’s level of physical activity;

                      (j)  whether the patient has bodily pain;

                     (k)  whether the patient has difficulty getting to sleep or staying asleep;

                      (l)  whether the patient has psychological distress;

                    (m)  whether the patient has posttraumatic stress disorder;

                     (n)  whether the patient is at risk of harm to self or others;

                     (o)  whether the patient has anger problems;

                     (p)  the patient’s sexual health;

                     (q)  any other health concerns the patient has.

             (6)  The assessment must also include the following:

                     (a)  measuring the patient’s height;

                     (b)  weighing the patient and ascertaining, or asking the patient, whether the patient’s weight has changed in the last 12 months;

                     (c)  measuring the patient’s waist circumference;

                     (d)  taking the patient’s blood pressure;

                     (e)  using information gained in the course of taking the patient’s history to assess whether any further assessment of the patient’s health is necessary;

                      (f)  either:

                              (i)  making the further assessment mentioned in paragraph (e); or

                             (ii)  referring the patient to another medical practitioner who can make the further assessment;

                     (g)  documenting a strategy for improving the patient’s health;

                     (h)  offering to give the patient a written report of the assessment that makes recommendations for treating the patient including preventive health measures.

             (7)  The doctor must keep a record of the assessment.

             (8)  In this clause:

usual doctor, in relation to a patient, means a general practitioner employed by a medical practice:

                     (a)  that has provided at least 50% of the primary health care required by the patient in the last 12 months; or

                     (b)  that the patient anticipates will provide at least 50% of the patient’s primary health care requirements in the next 12 months.

2.16.11  Aboriginal and Torres Strait Islander child health assessment

             (1)  An Aboriginal and Torres Strait Islander child health assessment is the assessment of:

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

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

             (2)  An Aboriginal and Torres Strait Islander child health assessment must include:

                     (a)  a personal attendance by a medical practitioner; and

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

                              (i)  mother’s pregnancy history;

                             (ii)  birth and neo‑natal history;

                            (iii)  breastfeeding history;

                            (iv)  weaning, food access and dietary history;

                             (v)  physical activity engaged in;

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

                           (vii)  relevant family medical history;

                          (viii)  immunisation status;

                            (ix)  vision and hearing (including neo‑natal hearing screening);

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

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

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

                          (xiii)  environmental and living conditions;

                          (xiv)  educational progress;

                           (xv)  stressful life events experienced;

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

                         (xvii)  substance use;

                        (xviii)  sexual and reproductive health;

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

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

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

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

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

                            (iv)  ear examination (including otoscopy);

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

                            (vi)  trachoma check, if indicated;

                           (vii)  skin examination, if indicated;

                          (viii)  respiratory examination, if indicated;

                            (ix)  cardiac auscultation, if indicated;

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

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

                           (xii)  other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment; and

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

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

                             (ii)  audiometry, especially for school age children; and

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

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

                     (g)  both:

                              (i)  keeping a record of the health assessment; and

                             (ii)  offering the patient, or the patient’s parent or carer, a written report on the health assessment, with recommendations on matters covered by the health assessment (including a strategy for the good health of the patient).

2.16.12  Aboriginal and Torres Strait Islander adult health assessment

             (1)  An Aboriginal and Torres Strait Islander adult health assessment is the assessment of:

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

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

             (2)  An Aboriginal and Torres Strait Islander adult health assessment must include:

                     (a)  personal attendance by a medical practitioner; and

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

                              (i)  current health problems and risk factors;

                             (ii)  relevant family medical history;

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

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

                             (v)  sexual and reproductive health;

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

                           (vii)  hearing loss;

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

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

                             (x)  vision; and

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

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

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

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

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

                             (v)  urinalysis (by dipstick) for proteinuria;

                            (vi)  eye examination; and

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

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

                             (ii)  papanicolaou smear;

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

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

                     (e)  assessing the patient using the information gained in the health assessment; and

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

             (3)  An Aboriginal and Torres Strait Islander adult health assessment must also include:

                     (a)  keeping a record of the health assessment; and

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

2.16.13  Aboriginal and Torres Strait Islander Older Person’s Health Assessment

             (1)  An Aboriginal and Torres Strait Islander Older Person’s Health Assessment is the assessment of:

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

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

             (2)  An Aboriginal and Torres Strait Islander Older Person’s Health Assessment must include:

                     (a)  personal attendance by a medical practitioner; and

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

                     (c)  assessment of the patient’s medication; and

                     (d)  assessment of the patient’s continence; and

                     (e)  assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and

                      (f)  assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months; and

                     (g)  assessment of the patient’s psychological function, including the patient’s cognition and mood; and

                     (h)  assessment of the patient’s social function, including:

                              (i)  the availability and adequacy of paid, and unpaid, help; and

                             (ii)  whether the patient is responsible for caring for another person; and

                      (i)  an examination of the patient’s eyes.

             (3)  An Aboriginal and Torres Strait Islander Older Person’s Health Assessment must also include:

                     (a)  keeping a record of the health assessment; and

                     (b)  offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment; and

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

2.16.14  Restrictions on health assessments for Group A14

             (1)  A health assessment mentioned in an item in Group A14 must not include a health screening service.

             (2)  A separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.

             (3)  A health assessment must be performed by the patient’s usual medical practitioner, if reasonably practicable.

             (4)  Practice nurses and Aboriginal and Torres Strait Islander health practitioners may assist medical practitioners in performing a health assessment, in accordance with accepted medical practice, and under the supervision of the medical practitioner.

             (5)  For subclause (4), assistance may include activities associated with:

                     (a)  information collection, and

                     (b)  at the direction of the medical practitioner—provision to patients of information on recommended interventions.

             (6)  In this clause:

health screening service has the same meaning as in subsection 19(5) of the Act.

 

Group A14—Health assessments

Item

Description

Fee ($)

701

Professional attendance by a medical practitioner (other than a specialist or consultant physician) to perform a brief health assessment, lasting not more than 30 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing the patient with preventive health care advice and information

59.35

703

Professional attendance by a medical practitioner (other than a specialist or consultant physician) to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:

(a) detailed information collection, including taking a patient history; and

(b) an extensive physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing a preventive health care strategy for the patient

137.90

705

Professional attendance by a medical practitioner (other than a specialist or consultant physician) to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient’s medical condition and physical function; and

(c) initiating interventions and referrals as indicated; and

(d) providing a basic preventive health care management plan for the patient

190.30

707

Professional attendance by a medical practitioner (other than a specialist or consultant physician) to perform a prolonged health assessment (lasting at least 60 minutes) including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient’s medical condition, and physical, psychological and social function; and

(c) initiating interventions or referrals as indicated; and

(d) providing a comprehensive preventive health care management plan for the patient

268.80

715

Professional attendance by a medical practitioner (other than a specialist or consultant physician) at consulting rooms or in another place other than a hospital or residential aged care facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent—not more than once in a 9 month period

212.25

Division 2.17Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Subdivision AGeneral

2.17.1  Service by medical practitioners

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

                     (a)  a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or

                     (b)  a medical practitioner who:

                              (i)  is employed by the proprietor of a hospital that is not a private hospital; and

                             (ii)  provides the service otherwise than in the course of employment by that proprietor.

             (2)  Paragraph (1)(b) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

Subdivision BSubgroup 1 of Group A15

2.17.2  Meaning of associated medical practitioner

                   In item 732 associated medical practitioner means a general practitioner who, if not engaged in the same general practice as the medical practitioner mentioned in the item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

2.17.3  Meaning of contribute to a multidisciplinary care plan

                   In items 729 and 731:

contribute to a multidisciplinary care plan, for a patient, includes the following:

                     (a)  preparing part of a multidisciplinary care plan and adding a copy of that part of the plan to the patient’s medical records;

                     (b)  preparing amendments to part of a multidisciplinary care plan and adding a copy of the amendments to the patient’s medical records;

                     (c)  giving advice to a person who prepares part of a multidisciplinary care plan and recording in writing, on the patient’s medical records, any advice provided to the person;

                     (d)  giving advice to a person who reviews part of a multidisciplinary care plan and recording in writing, on the patient’s medical records, any advice provided to the person.

2.17.4  Meaning of coordinating the development of team care arrangements

             (1)  In item 723:

coordinating the development of team care arrangements means a process by which a medical practitioner:

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

                     (b)  prepares a document that describes the following:

                              (i)  treatment and service goals for the patient;

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

                            (iii)  actions to be taken by the patient;

                            (iv)  arrangements to review the matters mentioned in subparagraphs (b)(i), (ii) and (iii) by a day mentioned in the document; and

                     (c)  undertakes all of the following activities:

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

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

                            (iii)  records the patient’s agreement to the development of team care arrangements;

                            (iv)  gives the collaborating provider a copy of those parts of the document that relate to the collaborating provider’s treatment of the patient’s condition;

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

                            (vi)  adds a copy of the document to the patient’s medical records.

             (2)  For this clause, a collaborating provider is a person who:

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

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

2.17.5  Meaning of coordinating a review of team care arrangements

             (1)  In item 732:

coordinating a review of team care arrangements means a process by which a medical practitioner:

                     (a)  in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and one of whom may be another medical practitioner, reviews the matters mentioned in paragraphs 2.17.4(1)(b) and 2.17.7(a), as applicable; and

                     (b)  if different arrangements need to be made—makes amendments to the plan, or to the document mentioned in paragraph 2.17.4(1)(b), that:

                              (i)  state the new arrangements; and

                             (ii)  provide for the review of the amended plan or document by a date stated in the plan or document; and

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

                     (d)  records the patient’s agreement to the review of team care arrangements or the plan; and

                     (e)  gives the collaborating provider a copy of those parts of the amended document, or the amended plan, that relate to the collaborating provider’s treatment of the patient’s condition; and

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

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

             (2)  For this clause, a collaborating provider is a person who:

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

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

2.17.6  Meaning of multidisciplinary care plan

             (1)  In items 729 and 731:

multidisciplinary care plan, for a patient, means a written plan that:

                     (a)  is prepared for the patient by:

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

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

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

             (2)  For this clause, a collaborating provider is a person, including a medical practitioner, who:

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

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

2.17.7  Meaning of preparing a GP management plan

                   In item 721:

preparing a GP management plan, for a patient, means a process by which a medical practitioner:

                     (a)  prepares a written plan for the patient that describes:

                              (i)  the patient’s condition and associated health care needs; and

                             (ii)  management goals with which the patient agrees; and

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

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

                             (v)  arrangements for providing the treatment and services mentioned in subparagraph (a)(iv); and

                            (vi)  arrangements to review the plan by a day mentioned in the plan.

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

                     (c)  records the plan; and

                     (d)  records the patient’s agreement to the preparation of the plan; and

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

                      (f)  adds a copy of the plan to the patient’s medical records.

2.17.8  Meaning of reviewing a GP management plan

                   In item 732:

reviewing a GP management plan means a process by which a medical practitioner:

                     (a)  reviews the matters mentioned in paragraph (a) of the definition of preparing a GP management plan in clause 2.17.7; and

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

                              (i)  state the new arrangements; and

                             (ii)  provide for a further review of the amended plan by a date stated in the plan; and

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

                     (d)  records the patient’s agreement to the review of the plan; and

                     (e)  if amendments are made to the plan:

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

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

2.17.9  Application of items 721, 723, 729, 731 and 732

             (1)  An item of the table mentioned in column 1 of table 2.17.9 applies only to a service for a patient who:

                     (a)  suffers from at least one medical condition that:

                              (i)  has been (or is likely to be) present for at least 6 months; or

                             (ii)  is terminal; and

                     (b)  is described in column 2 of table 2.17.9.

 

Table 2.17.9—Application of items 721, 723, 729, 731 and 732

Item

Column 1

Items of the table

Column 2

Description of patient

1

721 and 732
(if the service is for preparing a GP management plan or reviewing a GP management plan)

The patient:

(a) is a private in‑patient of a hospital; or

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

2

723 and 732
(if the service is for the creation or review of team care arrangements)

The patient:

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

(b) either:

(i) is a private in‑patient of a hospital; or

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

3

729

The patient:

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

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

4

731

The patient:

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

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

             (2)  For this clause, a collaborating provider is a person who:

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

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

2.17.10  Application of items 701 to 723 and 732

                   Items 701 to 723 and 732 apply only to a service provided in the course of personal attendance by a single medical practitioner on a single patient.

2.17.10A  Application of items in relation to items 721, 723 and 732

                   The following items do not apply to a service mentioned in the item that is provided by a medical practitioner, if the service is provided on the same day for the same patient for whom the practitioner provides a service mentioned in item 721, 723 or 732:

                     (a)  items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60 and 65;

                     (b)  items 597, 598, 599 and 600;

                     (c)  items 5000, 5003, 5020, 5023, 5040, 5043, 5060 and 5063;

                     (d)  items 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228.

2.17.11  Limitation on items 721, 723, 729, 731 and 732

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

             (2)  Items 721, 723, 729, 731 and 732 apply in the circumstances mentioned in table 2.17.11.

 

Table 2.17.11—Limitation on items 721, 723, 729, 731 and 732

Item

Item of the table

Circumstances

1

721

(a) In the 3 months before performance of the service, being a service to which item 729, 731 or 732 (for reviewing a GP management plan) applies but had not been performed for the patient; and

(b) the service is not performed more than once in a 12 month period; and

(c) the service is not performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

2

723

(a) In the 3 months before performance of the service, being a service to which item 732 (for coordinating a review of team care arrangements, a multi‑disciplinary community care plan or a multi‑disciplinary discharge care plan) applies but had not been performed for the patient; and

(b) the service is performed not more than once in a 12 month period; and

(c) the service is not performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

3

729

(a) either:

(i) in the 3 months before performance of the service, being a service to which item 731 or 732 applies but had not been performed for the patient; or

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

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

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

(b) the service is performed not more than once in a 3 month period

4

731

(a) In the 3 months before performance of the service, being a service to which item 721, 723, 729 or 732 applies but had not been performed for the patient; and

(b) the service is performed not more than once in a 3 month period

5

732

Each service may be performed:

(a) once in a 3 month period; and

(b) on the same day; but

(c) may not be performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

             (3)  In this clause:

exceptional circumstances, for a patient, means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

 

Group A15—GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Item

Description

Fee ($)

Subgroup 1—GP management plans, team care arrangements and multidisciplinary care plans

721

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), for preparation of a GP management plan for a patient (other than a service associated with a service to which any of items 735 to 758 apply)

144.25

723

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to coordinate the development of team care arrangements for a patient (other than a service associated with a service to which any of items 735 to 758 apply)

114.30

729

Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 735 to 758 apply)

70.40

731

Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to:

(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or

(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider

(other than a service associated with a service to which items 735 to 758 apply)

70.40

732

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to review or coordinate a review of:

(a) a GP management plan prepared by a medical practitioner (or an associated medical practitioner) to which item 721 applies; or

(b) team care arrangements which have been coordinated by the medical practitioner (or an associated medical practitioner) to which item 723 applies

72.05

Subdivision CSubgroup 2 of Group A15

2.17.12  Meaning of multidisciplinary discharge case conference

                   In items 735, 739, 743, 747, 750 and 758:

multidisciplinary discharge case conference means a multidisciplinary case conference carried out for a patient before the patient is discharged from a hospital.

2.17.13  Meaning of multidisciplinary case conference in a residential aged care facility

                   In items 735, 739, 743, 747, 750 and 758:

multidisciplinary case conference in a residential aged care facility means a multidisciplinary case conference carried out for a care recipient in a residential aged care facility.

2.17.14  Meaning of organise and coordinate

                   In items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866:

organise and coordinate, for a conference mentioned in the item, means undertaking all of the following activities:

                     (a)  explaining to the patient the nature of the conference;

                     (b)  asking the patient whether the patient agrees to the conference taking place;

                     (c)  recording the patient’s agreement to the conference;

                     (d)  recording the day the conference was held and the times the conference started and ended;

                     (e)  recording the names of the participants;

                      (f)  recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.2 and putting a copy of that record in the patient’s medical records;

                     (g)  offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

                     (h)  discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

2.17.15  Meaning of participate

                   In items 747, 750, 758, 825, 826, 828, 835, 837 and 838:

participate, for a conference mentioned in the item, means participation that:

                     (a)  does not include organising and coordinating the conference; and

                     (b)  involves undertaking all of the following activities in relation to the conference:

                              (i)  explaining to the patient the nature of the conference;

                             (ii)  asking the patient whether the patient agrees to the practitioner’s participation in the conference;

                            (iii)  recording the patient’s agreement to the practitioner’s participation in the conference;

                            (iv)  recording the day the conference was held and the times the conference started and ended;

                             (v)  recording the names of the participants;

                            (vi)  recording the matters mentioned in clause 1.1.2 and putting a copy of that record in the patient’s medical records.

2.17.16  Meaning of coordinating

                   In item 880:

coordinating, for a case conference, means undertaking all of the following activities:

                     (a)  coordinating and facilitating the case conference;

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

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

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

2.17.17  Meaning of case conference team

                   For item 880, a case conference team:

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

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

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

Example:    For paragraph (b), persons who may be included in a team are the following:

(a)    dieticians;

(b)    mental health workers;

(c)    occupational therapists;

(d)    pharmacists;

(e)    physiotherapists;

(f)    podiatrists;

(g)    psychologists;

(h)    social workers;

(i)     speech pathologists.

2.17.18  Application of item 880

             (1)  Item 880 applies if:

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

                     (b)  the attendance is on a patient who:

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

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

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

                                        (A)  geriatric evaluation and management;

                                        (B)  rehabilitation care.

             (2)  In this clause:

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

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

 

Group A15—GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Item

Description

Fee ($)

Subgroup 2—Case conferences

735

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which items 721 to 732 apply)

70.65

739

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

120.95

743

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

201.65

747

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which items 721 to 732 apply)

51.90

750

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

89.00

758

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

148.20

820

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

139.10

822

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

208.70

823

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

278.15

825

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

99.90

826

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

159.30

828

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

218.75

830

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

139.10

832

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

208.70

834

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

278.15

835

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

99.90

837

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

159.30

838

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

218.75

855

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

139.10

857

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

208.70

858

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

278.15

861

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

139.10

864

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

208.70

866

Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

278.15

871

Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to lead and coordinate a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 3 other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

80.30

872

Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 4 medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

37.40

880

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of geriatric or rehabilitation medicine, as a member of a case conference team, to coordinate a case conference of at least 10 minutes but less than 30 minutes—for any particular patient, one attendance only in a 7 day period (other than attendance on the same day as an attendance for which item 832, 834, 835, 837 or 838 was applicable in relation to the patient) (H)

48.65

Division 2.18Group A17: Domiciliary and residential medication management reviews

2.18.1  Meaning of living in a community setting

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

2.18.2  Meaning of residential medication management review

             (1)  In item 903:

residential medication management review means a collaborative service provided by a medical practitioner and a pharmacist to review the medication management needs of a permanent resident of a residential aged care facility.

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

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

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

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

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

                              (i)  the findings of the review; and

                             (ii)  medication management strategies; and

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

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

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

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

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

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

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

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

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

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

2.18.3  Application of items 900 and 903

                   Items 900 and 903 apply only to a service provided in the course of personal attendance by a single medical practitioner on a single patient.

 

Group A17—Domiciliary medication management review

Item

Description

Fee ($)

900

Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for patients living in a community setting, in which the medical practitioner:

(a) assesses a patient’s medication management needs and, following that assessment, refers the patient to a community pharmacy or an accredited pharmacist for a DMMR and, with the patient’s consent, provides relevant clinical information required for the review; and

(b) discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and

(c) develops a written medication management plan following discussion with the patient

For any particular patient—applicable not more than once in each 12 month period, except if there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR

154.80

903

Participation by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) in a residential medication management review (RMMR) for a patient who is a permanent resident of a residential aged care facility—other than an RMMR for a resident in relation to whom, in the preceding 12 months, this item has applied, unless there has been a significant change in the resident’s medical condition or medication management plan requiring a new RMMR

106.00

Division 2.18AGroup A30: Medical practitioner video conferencing consultation

2.18A.1  Application of items

             (1)  An item in Group A30 may be claimed if:

                     (a)  the service described in the item is undertaken in association with a service described in an item mentioned in sub‑clause (2); and

                     (b)  no other service described in an item in Group A30 is provided to the patient on the same occasion.

             (2)  For subclause (1), the items are 99, 112, 113, 114, 149, 288, 384, 389, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.

2.18A.2  Application of items 2125, 2138, 2179 and 2220

                   For items 2125, 2138, 2179 and 2220, professional attendance may be provided by the medical practitioner at consulting rooms in the residential care service if the patient is a care recipient.

2.18A.3  Meaning of amount under clause 2.18A.3

                   An amount under clause 2.18A.3, for an item mentioned in column 1 of table 2.18A.3, means the sum of:

                     (a)  the fee for the item mentioned in column 2 of the table; and

                     (b)  the fee for the item mentioned in:

                              (i)  if the medical practitioner attends no more than 6 patients in a single attendance—the amount mentioned in column 3 of the table, divided by the number of patients attended; or

                             (ii)  if the medical practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 4 of the table.

 

Table 2.18A.3—Amount under clause 2.18A.3

Item

Column 1

Item of the table

Column 2

Fee

Column 3

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

Column 4

Amount per patient if more than 6 patients ($)

1

2122

The fee for item 2100

25.95

2.00

2

2125

The fee for item 2100

46.70

3.30

3

2137

The fee for item 2126

25.95

2.00

4

2138

The fee for item 2126

46.70

3.30

5

2147

The fee for item 2143

25.95

2.00

6

2179

The fee for item 2143

46.70

3.30

7

2199

The fee for item 2195

25.95

2.00

8

2220

The fee for item 2195

46.70

3.30

 

2.18A.4  Limitation of items

                   Items 2100, 2122, 2126, 2137, 2143, 2147, 2195 and 2199 do not apply if the patient or the specialist or consultant physician mentioned in paragraph (a) of the item travels to a place to satisfy the requirement:

                     (a)  for items 2100, 2126, 2143 and 2195—in sub‑subparagraph (c)(i)(B) of the item; and

                     (b)  for items 2122, 2137, 2147 and 2199—in subparagraph (d)(ii) of the item.

 

Group A30—Medical Practitioner (including a general practitioner, specialist or consultant physician) video conferencing consultation

Item

Description

Fee ($)

Subgroup 1—Video conferencing consultation attendance at consulting rooms, home visit or other institution

2100

Professional attendance at consulting rooms of at least 5 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

      for which a direction made under subsection 19(2) of the Act applies

22.90

2122

Professional attendance not in consulting rooms of at least 5 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential care service; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

2126

Professional attendance at consulting rooms of less than 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

49.95

2137

Professional attendance not in consulting rooms of less than 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential care service; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

2143

Professional attendance at consulting rooms of at least 20 minutes in duration (whether or not continuous) by a medical practitioner who provides clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

      for which a direction made under subsection 19(2) of the Act applies

96.85

2147

Professional attendance not in consulting rooms of at least 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential care service; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

2195

Professional attendance at consulting rooms of at least 40 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

142.50

2199

Professional attendance not in consulting rooms of at least 40 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential care service; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 kms by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

Subgroup 2—Video conferencing consultation attendance at a residential aged care service

2125

Professional attendance of at least 5 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential care service; and

(c) is not a resident of a self‑contained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

2138

 Professional attendance of less than 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential care service; and

(c) is not a resident of a self‑contained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

2179

Professional attendance of at least 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential care service; and

(c) is not a resident of a self‑contained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

2220

Professional attendance of at least 40 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential care service; and

(c) is not a resident of a self‑contained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under table 2.18A.3

Division 2.19Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies)

2.19.1  Application of Subgroup 2 of Groups A18 and A19

             (1)  An item in Subgroup 2 of Group A18 or A19 does not apply to a service that is provided to a patient who has already been provided, in the previous 11 months, with another service mentioned in that Subgroup.

             (2)  For an item in Subgroup 2 of Group A18 or A19, a professional attendance completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus if the attendance completes a series of attendances that involve, over a period of at least 11 months and up to 13 months, (the current cycle), the following:

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

                     (b)  subject to subclause (3), if the patient has not had a comprehensive eye examination in the cycle of care ending immediately before the current cycle—at least one comprehensive eye examination;

                     (c)  measurement of the patient’s weight and height, and calculation of the patient’s BMI;

                     (d)  2 further measurements of the patient’s weight with each measurement being taken at least 5 months after the previous measurement;

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

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

                     (g)  at least one measurement of the patient’s total cholesterol, triglycerides and HDL cholesterol;

                     (h)  at least one test of the patient’s microalbuminuria;

                   (ha)  at least one measurement of the patient’s estimated Glomerular Filtration Rate (eGFR);

                      (i)  provision to the patient of self‑management education regarding diabetes;

                      (j)  a review of the patient’s diet, and provision to the patient of information about appropriate dietary choices;

                     (k)  a review of the patient’s level of physical activity, and provision to the patient of information about the appropriate level of physical activity;

                      (l)  checking the patient’s tobacco smoking activity, and, if relevant, encouraging the patient to stop smoking;

                    (m)  a review of the patient’s medication.

             (3)  For a patient with established diabetes mellitus who has a condition that is mentioned in table 2.19.1, the minimum requirements of a cycle of care for the patient in relation to paragraphs (2)(b) and (f) may be completed as set out in that table.

 

Table 2.19.1—Minimum requirements of a cycle of care

Item

Patient’s condition

How minimum requirements completed

1

A patient who is blind

Without an eye examination

2

A patient who has sight in only one eye

Examination of that eye

3

A patient who does not have any feet

Without a foot examination

4

A patient who has only one foot

Examination of that foot

2.19.2  Application of Subgroup 3 of Groups A18 and A19

             (1)  An item in Subgroup 3 of Group A18 or A19 does not apply to a service that:

                     (a)  is provided to a patient who has already been provided, in the previous 12 months, with another service mentioned in Subgroup 3 of Group A18 or A19; and

                     (b)  is not clinically indicated.

             (2)  For an item in Subgroup 3 of Group A18 or A19, a professional attendance completes the minimum requirements of the Asthma Cycle of Care if the attendance completes a series of attendances that involves:

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

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

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

                             (ii)  either:

                                        (A)  provision to the patient of a written asthma action plan; or

                                        (B)  if the patient is unable to use a written asthma action plan—discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient’s medical records;

                            (iii)  provision of asthma self‑management education to the patient;

                            (iv)  at the review consultation:

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

                                        (B)  if necessary, adjustment of that plan.

 

Group A18—General practitioner attendances associated with Practice Incentives Program (PIP) payments

Item

Description

Fee ($)

Subgroup 1—Taking of a cervical smear from an unscreened or significantly underscreened person

2497

Professional attendance at consulting rooms by a general practitioner:

(a) involving taking a short patient history and, if required, limited examination and management; and

(b) at which a cervical smear is taken from a person between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years

16.95

2501

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years

37.05

2503

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years

Amount under clause 2.1.1

2504

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years

71.70

2506

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years

Amount under clause 2.1.1

2507

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years

105.55

2509

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years

Amount under clause 2.1.1

Subgroup 2—Completion of a cycle of care for patients with established diabetes mellitus

2517

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

37.05

2518

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Amount under clause 2.1.1

2521

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

71.70

2522

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Amount under clause 2.1.1

2525

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

105.55

2526

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Amount under clause 2.1.1

Subgroup 3—Completion of the Asthma Cycle of Care

2546

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

37.05

2547

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2552

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

71.70

2553

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2558

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

105.55

2559

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

Amount under clause 2.1.1

 

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

 

 

Group A19—Other non‑referred attendances associated with Practice Incentives Program (PIP) payments to which no other item applies

Item

Description

Fee ($)

Subgroup 1—Taking of a cervical smear from an unscreened or significantly underscreened person

2598

Professional attendance at consulting rooms of less than 5 minutes in duration by a medical practitioner who practices in general practice (other than a general practitioner) at which a cervical smear is taken from a person between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years

11.00

2600

Professional attendance at consulting rooms of more than 5, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years

21.00

2603

Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years

38.00

2606

Professional attendance at consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years

61.00

2610

Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years

Amount under clause 2.1.1

2613

Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years

Amount under clause 2.1.1

2616

Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years

Amount under clause 2.1.1

Subgroup 2—Completion of a cycle of care for patients with established diabetes mellitus

2620

Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

21.00

2622

Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the requirements for a cycle of care of a patient with established diabetes mellitus

38.00

2624

Professional attendance at consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

61.00

2631

Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under clause 2.1.1

2633

Professional attendance at a place other than consulting rooms of more than 25 minutes but not more than 45 minutes, in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under clause 2.1.1

2635

Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under clause 2.1.1

Subgroup 3—Completion of the Asthma Cycle of Care

2664

 

Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

21.00

2666

Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

38.00

2668

Professional attendance at consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

61.00

2673

Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2675

Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2677

Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

Division 2.20Group A20: Mental health care

2.20.1  Definitions

                   In this Division:

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

                     (a)  psycho‑education;

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

                     (c)  relaxation strategies;

                     (d)  skills training;

                     (e)  interpersonal therapy.

mental disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:

                     (a)  may require medical intervention; and

                     (b)  may be a recognised, medically diagnosable illness or disorder; and

                     (c)  is not dementia, delirium, tobacco use disorder or mental retardation.

Note:          In relation to this definition, attention is drawn to the Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD‑10, Chapter 5, Primary Care Version), developed by the World Health Organisation and published in 1996.

outcome measurement tool means a tool used to monitor changes in a patient’s health that occur in response to treatment received by the patient.

2.20.2  Meaning of amount under clause 2.20.2

                   In items 2723 and 2727:

amount under clause 2.20.2, for an item mentioned in column 1 of table 2.20.2, means the sum of:

                     (a)  the fee mentioned in column 2 for the item; and

                     (b)  either:

                              (i)  if not more than 6 patients are attended at a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

                             (ii)  if more than 6 patients are attended at a single attendance—the amount mentioned in column 4 for the item.

 

Table 2.20.2—Amount under clause 2.20.2

Item

Column 1

Item of the table

Column 2

Fee

Column 3

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

Column 4

Amount if more than 6 patients ($)

1

2723

The fee for item 2721

25.95

2.00

2

2727

The fee for item 2725

25.95

2.00

2.20.3  Meaning of preparation of a GP mental health treatment plan

             (1)  The preparation of a GP mental health treatment plan, for a patient, means each of the following:

                     (a)  preparation of a written plan by a medical practitioner for the patient that includes:

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

                             (ii)  formulation of the mental disorder, including provisional diagnosis or diagnosis; and

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

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

                             (v)  a plan for either or both of the following:

                                        (A)  crisis intervention;

                                        (B)  relapse prevention; and

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

                           (vii)  arrangements for providing the referral and treatment options mentioned in subparagraph (a)(vi); and

                          (viii)  arrangements to review the plan;

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

                     (c)  recording the plan;

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

                     (e)  offering the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

                              (i)  a copy of the plan; and

                             (ii)  suitable education about the mental disorder;

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

             (2)  In subparagraph (1)(a)(vi), referral and treatment options, for a patient, includes:

                     (a)  support services for the patient; and

                     (b)  psychiatric services for the patient; and

                     (c)  subject to the applicable limitations:

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

                             (ii)  focussed psychological strategies services provided to the patient by a medical practitioner mentioned in paragraph 2.20.7(1)(b) to provide those services (items 2721 to 2727); and

                            (iii)  focussed psychological strategies services provided to the patient by an allied mental health professional (items 80100 to 80170).

Note:          For items 80000 to 80020 and 80100 to 80170, see the determination about allied health services under subsection 3C(1) of the Act.

2.20.4  Meaning of review of a GP mental health treatment plan

                   A review of a GP mental health treatment plan means a process by which a medical practitioner:

                     (a)  reviews the matters mentioned in paragraph (a) of the definition of preparation of a GP mental health treatment plan in clause 2.20.3; and

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

                     (c)  if appropriate and if not previously provided—prepares a plan for either or both of the following:

                              (i)  crisis intervention;

                             (ii)  relapse prevention;

                     (d)  re‑administers the outcome measurement tool used in the assessment mentioned in subparagraph (1)(a)(i) of the definition of preparation of a GP mental health treatment plan in clause 2.20.3 (except if considered clinically inappropriate); and

                     (e)  if different arrangements need to be made—makes amendments to the plan that state those new arrangements; and

                      (f)  explains to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review of the plan; and

                     (g)  records the patient’s agreement to the review of the plan; and

                     (h)  if amendments are made to the plan:

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

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

2.20.5  Meaning of associated medical practitioner

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

2.20.6  Application of Subgroup 1 of Group A20

             (1)  Items 2700, 2701, 2712, 2713, 2715 and 2717 apply only to a patient with a mental disorder.

             (2)  Items 2700, 2701, 2712, 2715 and 2717 apply only to:

                     (a)  a patient in the community; and

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

                     (c)  a service provided in the course of personal attendance by a single medical practitioner on a single patient.

             (3)  Unless exceptional circumstances exist, items 2700, 2701, 2715 and 2717 cannot be claimed:

                     (a)  with a service to which items 735 to 758, or item 2713 apply; or

                     (b)  more than once in a 12 month period from the provision of any of the items for a particular patient; or

                     (c)  within 3 months following the provision of a service to which item 2712, or item 2719 of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (as in force on 29 February 2012), applies; or

                     (d)  more than once in a 12 month period from the provision of a service to which item 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 (as in force on 31 October 2011) applies for the patient.

             (4)  Item 2712 applies only if one of the following services has been provided to the patient:

                     (a)  the preparation of a GP mental health treatment plan under:

                              (i)  items 2700, 2701, 2715 and 2717; or

                             (ii)  items 2702 and 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 (as in force on 31 October 2011);

                     (b)  a review of a GP mental health treatment plan under item 2712, or item 2719 of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (as in force on 29 February 2012);

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

             (5)  Item 2712 does not apply:

                     (a)  to a service to which items 735 to 758, or item 2713 apply; or

                     (b)  unless exceptional circumstances exist for the provision of the service:

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

                             (ii)  within 4 weeks following the preparation of a GP mental health treatment plan (item 2700, 2701, 2715 or 2717); or

                     (c)  unless exceptional circumstances exist for the provision of the service to a patient within 3 months after the patient is provided a service to which item 2719 of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (as in force on 29 February 2012) applies.

             (6)  Item 2713 applies only:

                     (a)  to a surgery consultation; and

                     (b)  to an attendance of at least 20 minutes in duration.

             (7)  Item 2713 does not apply in association with a service to which item 2700, 2701, 2715, 2717 or 2712 applies.

             (8)  Items 2715 and 2717 apply only if the medical practitioner providing the service has successfully completed mental health skills training accredited by the General Practice Mental Health Standards Collaboration.

Note:          The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

             (9)  In this clause:

exceptional circumstances means a significant change in:

                     (a)  the patient’s clinical condition; or

                     (b)  the patient’s care circumstances.

2.20.7  Focussed psychological strategies

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

                     (a)  is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

                     (b)  is provided by a medical practitioner:

                              (i)  whose name is entered in the register maintained by the Chief Executive Medicare under regulation 30 of the Human Services (Medicare) Regulations 1975; and

                             (ii)  who is identified in the register as a practitioner who can provide services to which Subgroup 2 of Group A20 applies; and

                            (iii)  who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 applies.

             (2)  An item in Subgroup 2 of Group A20 does not apply to:

                     (a)  a service which:

                              (i)  is provided to a patient who, in a calendar year, has already been provided with 6 services to which any of the items in Subgroup 2 applies; and

                             (ii)  is provided before the medical practitioner managing the GP mental health treatment plan or the psychiatrist assessment and management plan has conducted a patient review and recorded in the patient’s records a recommendation that the patient have additional sessions of focussed psychological strategies in the same calendar year; or

                     (b)  a service which:

                              (i)  for the period from 1 March 2012 to 31 December 2012—is provided to a patient who has already been provided, in the calendar year, with 10 (or if exceptional circumstances exist—16) other services to which any of the items in Subgroup 2, or items 80000 to 80015, 80100 to 80115, 80125 to 80140 or 80150 to 80165 apply; and

                             (ii)  for each subsequent calendar year—is provided to a patient who has already been provided, in the calendar year, with 10 other services to which any of the items in Subgroup 2, or items 80000 to 80015, 80100 to 80115, 80125 to 80140 or 80150 to 80165 apply.

Note:          For items 80000 to 80015, 80100 to 80115, 80125 to 80140 and 80150 to 80165, see the determination about allied health services under subsection 3C(1) of the Act.

 

Group A20—Mental health care

Item

Description

Fee ($)

Subgroup 1—GP mental health treatment plans

2700

Professional attendance by a medical practitioner (including a general practitioner who has not undertaken mental health skills training, but not including a specialist or consultant physician) of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

71.70

2701

Professional attendance by a medical practitioner (including a general practitioner who has not undertaken mental health skills training, but not including a specialist or consultant physician) of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

105.55

2712

Professional attendance by a medical practitioner (not including a specialist or consultant physician) to review a GP mental health treatment plan which he or she, or an associated medical practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan

71.70

2713

Professional attendance by a medical practitioner (not including a specialist or consultant physician) in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation

71.70

2715

Professional attendance by a medical practitioner (including a general practitioner who has undertaken mental health skills training, but not including a specialist or consultant physician) of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

91.05

2717

Professional attendance by a medical practitioner (including a general practitioner who has undertaken mental health skills training, but not including a specialist or consultant physician) of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

134.10

Subgroup 2—Focussed psychological strategies

2721

Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

92.75

2723

Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

Amount under clause 2.20.2

2725

Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

132.75

2727

Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

Amount under clause 2.20.2

Division 2.21Group A24: Palliative and pain medicine

2.21.1  Meaning of organise and coordinate

                   In the items mentioned in Subgroups 2 and 4 of Group A24:

organise and coordinate, for a conference mentioned in the item, means undertaking all of the following activities:

                     (a)  explaining to the patient the nature of the conference;

                     (b)  asking the patient whether the patient agrees to the conference taking place;

                     (c)  recording the patient’s agreement to the conference;

                     (d)  recording the day the conference was held and the times the conference started and ended;

                     (e)  recording the names of the participants;

                      (f)  recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.2 and putting a copy of that record in the patient’s medical records;

                     (g)  offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

                     (h)  discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

2.21.2  Meaning of participate

                   In items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088 and 3093:

participate, for a conference mentioned in the item, means participation that:

                     (a)  if the conference is a community case conference—is at the request of the person who organises and coordinates the conference; and

                     (b)  involves undertaking all of the following activities in relation to the conference:

                              (i)  explaining to the patient the nature of the conference;

                             (ii)  asking the patient whether the patient agrees to the practitioner’s participation in the conference;

                            (iii)  recording the patient’s agreement to the practitioner’s participation in the conference;

                            (iv)  recording the day the conference was held and the times the conference started and ended;

                             (v)  recording the names of the participants;

                            (vi)  recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.2 and putting a copy of that record in the patient’s medical records; but

                     (c)  if the conference is a community case conference—does not include organising and coordinating the conference.

2.21.3  Application of Group A24

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

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

2.21.4  Limitation on items

                   The items in Subgroups 2 and 4 of Group A24 may only apply to a patient 5 times in a 12 month period.

2.21.5  Limitation of items

                   Items 2799, 2820, 3003 and 3015 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:

                     (a)  for items 2799 and 3003—sub‑subparagraph(c)(i)(B) of the item; and

                     (b)  for items 2820 and 3015—sub‑subparagraph (d)(i)(B) of the item.

 

Group A24—Palliative and pain medicine

Item

Description

Fee ($)

Subgroup 1—Pain medicine attendances

2799

Initial professional attendance of 10 minutes or less in duration on a patient by a specialist or consultant physician practising in his or her specialty of pain medicine if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

113.20

2801

 

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

150.90

2806

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 2814 applies) after the first in a single course of treatment

75.50

2814

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment

43.00

2820

Professional attendance on a patient by a specialist or consultant physician practising in his or her specialty of pain medicine if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 2801 lasting more than 10 minutes; or

(ii) provided with item 2806 or 2814; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 2801, 2806 or 2814

2824

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

183.10

2832

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 2840 applies) after the first in a single course of treatment

110.75

2840

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment

79.75

Subgroup 2—Pain medicine case conferences

2946

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes

139.10

2949

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes

208.70

2954

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 45 minutes

278.15

2958

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes

99.90

2972

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes

159.30

2974

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes

218.75

2978

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

139.10

2984

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

208.70

2988

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, before the patient is discharged from a hospital (H)

278.15

2992

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

99.90

2996

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

159.30

3000

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 45 minutes, before the patient is discharged from a hospital (H)

218.75

Subgroup 3—Palliative medicine attendances

3003

Initial professional attendance of 10 minutes or less in duration on a patient by a specialist or consultant physician practising in his or her specialty of palliative medicine if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

113.20

3005

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

150.90

3010

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 3014 applies) after the first in a single course of treatment

75.50

3014

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment

43.00

3015

Professional attendance on a patient by a specialist or consultant physician practising in his or her specialty of palliative medicine if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 3005 lasting more than 10 minutes; or

(ii) provided with item 3010 or 3014; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist or physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 3005, 3010 or 3014

3018

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

183.10

3023

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 3028 applies) after the first in a single course of treatment

110.75

3028

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment

79.75

Subgroup 4—Palliative medicine case conferences

3032

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes

139.10

3040

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes

208.70

3044

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 45 minutes

278.15

3051

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes

99.90

3055

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

159.30

3062

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes

218.75

3069

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

139.10

3074

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

208.70

3078

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, before the patient is discharged from a hospital (H)

278.15

3083

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

99.90

3088

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

159.30

3093

Attendance by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 45 minutes, before the patient is discharged from a hospital (H)

218.75

Division 2.22Group A27: Pregnancy support counselling

2.22.1  Application of item 4001

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

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

Note:          For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.

             (3)  In item 4001:

non‑directive pregnancy support counselling means counselling provided by a medical practitioner to a person in which:

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

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

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

 

Group A27—Pregnancy support counselling

Item

Description

Fee ($)

4001

Professional attendance of at least 20 minutes in duration at consulting rooms by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a person who:

76.60

 

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 81000, 81005 or 81010 applies in relation to that pregnancy

Note:       For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.

 

Division 2.23Group A22: General practitioner after‑hours attendances to which no other item applies

2.23.1  Application of Group A22

             (1)  Items 5000, 5020, 5040 and 5060 apply only to a professional attendance that is provided:

                     (a)  on a public holiday; or

                     (b)  on a Sunday; or

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

                     (d)  before 8 am, or after 8 pm, on a day other than a day mentioned in paragraphs (a) to (c).

             (2)  Items 5003, 5010, 5023, 5028, 5043, 5049, 5063 and 5067 apply only to a professional attendance that is provided in an after‑hours period.

 

Group A22—General practitioner after‑hours attendances to which no other item applies

Item

Description

Fee ($)

5000

Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—each attendance

29.00

5003

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies) that requires a short patient history and, if necessary, limited examination and management—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5010

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5020

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

49.00

5023

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5028

Professional attendance by a general practitioner (other than a service to which another item in the table applies), at a residential aged care facility to residents of the facility, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5040

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

83.95

5043

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5049

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5060

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

117.75

5063

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5067

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

Division 2.24Group A23: Other non‑referred after‑hours attendances to which no other item applies

2.24.1  Application of Group A23

             (1)  Items 5200, 5203, 5207 and 5208 apply only to a professional attendance that is provided:

                     (a)  on a public holiday; or

                     (b)  on a Sunday; or

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

                     (d)  before 8 am, or after 8 pm, on a day other than a day mentioned in paragraphs (a) to (c).

             (2)  Items 5220 to 5267 apply only to a professional attendance that is provided in an after‑hours period.

 

Group A23—Other non‑referred after‑hours attendances to which no other item applies

Item

Description

Fee ($)

5200

Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance

21.00

5203

Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance

31.00

5207

Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance

48.00

5208

Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance

71.00

5220

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting not more than 5 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5223

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 5 minutes, but not more than 25 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5227

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 25 minutes, but not more than 45 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5228

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 45 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5260

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of not more than 5 minutes in duration by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5263

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes in duration by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5265

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5267

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 45 minutes in duration by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

Division 2.26Group A26: Neurosurgery attendances to which no other item applies

2.26.1  Limitation of items 6004 and 6016

                   Items 6004 and 6016 do not apply if the patient or specialist travels to a place to satisfy the requirement in:

                     (a)  for item 6004—sub‑subparagraph (c)(i)(B) of the item; and

                     (b)  for item 6016—sub‑subparagraph (d)(i)(B) of the item.

 

Group A26—Neurosurgery attendances to which no other item applies

Item

Description

Fee ($)

6004

Initial professional attendance of 10 minutes or less in duration on a patient by a specialist practising in his or her specialty of neurosurgery if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

97.20

6007

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at consulting rooms or hospital

129.60

6009

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—a minor attendance after the first in a single course of treatment at consulting rooms or hospital

43.00

6011

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance after the first in a single course of treatment, involving an extensive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 15 minutes in duration but not more than 30 minutes in duration at consulting rooms or hospital

85.55

6013

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance after the first in a single course of treatment, involving a detailed and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 30 minutes in duration but not more than 45 minutes in duration at consulting rooms or hospital

118.50

6015

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance after the first in a single course of treatment, involving an exhaustive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 45 minutes in duration at consulting rooms or hospital

150.90

6016

Professional attendance on a patient by a specialist practising in his or her specialty of neurosurgery if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 6007 lasting more than 10 minutes; or

(ii) provided with item 6009, 6011, 6013 or 6015; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 6007, 6009, 6011, 6013 or 6015

Division 2.27Group A9: Contact lenses

2.27.1  Application of item 10809

                   Item 10809 does not apply if the patient’s requirement for contact lenses is only for any of the following reasons:

                     (a)  because the patient does not want to wear spectacles for reasons of appearance;

                     (b)  because the patient wants contact lenses for work or sporting purposes;

                     (c)  because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.

 

Group A9—Contact lenses

Item

Description

Fee ($)

10801

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with myopia of 5.0 dioptres or greater (spherical equivalent) in one eye

121.65

10802

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in one eye

121.65

10803

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with astigmatism of 3.0 dioptres or greater in one eye

121.65

10804

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens

121.65

10805

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

121.65

10806

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes and for whom a contact lens is prescribed as part of a telescopic system

121.65

10807

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin

121.65

10808

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient who, because of physical deformity, are unable to wear spectacles

121.65

10809

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10806, 10807 or 10808 applies) requiring the use of a contact lens for correction, if the condition is specified on the patient’s account

121.65

10816

Attendance for the refitting of contact lenses with keratometry and testing with trial lenses and the issue of a prescription, if the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structural or functional change in the eye or an allergic response within 36 months after the fitting of a contact lens to which items 10801 to 10809 apply

121.65

Division 2.28Group A10: Optometric services provided by participating optometrist

2.28.1  Applications of items 10940 and 10941

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

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

2.28.2  Application of item 10929

                   Item 10929 does not apply if the patient’s requirement for contact lenses is only for any of the following reasons:

                     (a)  because the patient does not want to wear spectacles for reasons of appearance;

                     (b)  because the patient wants contact lenses for work or sporting purposes;

                     (c)  because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.

2.28.3  Limitation on items

             (1)  Item 10943 may only apply to a patient once in a 12 month period.

             (2)  Item 10942 may only apply to a patient twice in a 12 month period.

             (3)  Items 10921 to 10929 may only apply to a patient once in a 36 month period.

2.28.4  Application of items 10931, 10932 and 10933

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

             (3)  In items 10931, 10932 and 10933:

bulk‑billed, for a medical service, means:

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

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

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

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

2.28.5  Limitation of item 10943

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

2.28.6  Meaning of old item 10900

                   In the items in Group A10:

old item 10900 means item 10900 of the table as it was in force at any time before its repeal by Part 1 of Schedule 1 to the Health Insurance Legislation Amendment (Optometric Services and Other Measures) Regulation 2014

 

Group A10—Optometric services provided by participating optometrist

Item

Description

Fee ($)

10905

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has been referred by another optometrist who is not associated with the optometrist to whom the patient is referred

66.80

10907

Professional attendance of more than 15 minutes in duration, being the first in a course of attention if the patient has attended another optometrist for an attendance to which this item or item 10905, 10910, 10911, 10912, 10913, 10914 or 10915 applies, or to which old item 10900 applied:

(a) for a patient who is less than 65 years of age—within the previous 36 months; or

(b) for a patient who is at least 65 years of age—within the previous 12 months

33.45

10910

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:

(a) the patient is less than 65 years of age; and

(b) the patient has not, within the previous 36 months, received a service to which:

(i) this item or item 10905, 10907, 10912, 10913, 10914 or 10915 applies; or

(ii) old item 10900 applied

66.80

10911

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:

(a) the patient is at least 65 years of age; and

(b) the patient has not, within the previous 12 months, received a service to which:

(i) this item, or item 10905, 10907, 10910, 10912, 10913, 10914 or 10915 applies; or

(ii) old item 10900 applied

66.80

10912

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has suffered a significant change of visual function requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10913, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10913, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied

66.80

10913

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has new signs or symptoms, unrelated to the earlier course of attention, requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10912, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10914 or 10915 at the same practice applies; or

(ii) old item 10900 at the same practice applied

66.80

10914

Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment:

(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10912, 10913 or 10915 applies; or

(ii) old item 10900 applied; or

(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:

(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10913 or 10915 applies; or

(ii) old item 10900 applied

66.80

10915

Professional attendance of more than 15 minutes in duration, being the first in a course of attention involving the examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus, requiring comprehensive reassessment

66.80

10916

Professional attendance, being the first in a course of attention, of not more than 15 minutes in duration (other than a service associated with a service to which item 10931, 10932, 10933, 10940, 10941, 10942 or 10943 applies)

33.45

10918

Professional attendance, being the second or subsequent in a course of attention and being unrelated to the prescription and fitting of contact lenses (other than a service associated with a service to which item 10940 or 10941 applies)

33.45

10921

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with myopia of 5.0 dioptres or greater (spherical equivalent) in one eye

165.80

10922

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in one eye

165.80

10923

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with astigmatism of 3.0 dioptres or greater in one eye

165.80

10924

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens

209.20

10925

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

165.80

10926

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a contact lens is prescribed as part of a telescopic system

165.80

10927

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin

209.20

10928

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients who, because of physical deformity, are unable to wear spectacles

165.80

10929

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:

(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or

(b) old item 10900 applied

For patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10926, 10927 or 10928 applies) requiring the use of a contact lens for correction, if the condition is specified on the patient’s account

209.20

10930

All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses if the patient meets the requirements of an item in the series 10921 to 10929 and requires a change in contact lens material or basic lens parameters, other than a simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens covered by items 10921 to 10929

165.80

10931

A service to which an item in Group A10 applies (other than this item or item 10916, 10932, 10933, 10940 or 10941), if the service:

(a) is provided:

(i) during a home visit to a person; or

(ii) in a residential aged care facility; or

(iii) in an institution; and

(b) is provided to a single patient at a single location on a single occasion; and

(c) is:

(i) bulk‑billed for the fees for this item and another item in the table applying to the service; or

(ii) not bulk‑billed for the fees for this item and another item in the table applying to the service

23.30

10932

A service to which an item in Group A10 applies (other than this item or item 10916, 10931, 10933, 10940 or 10941), if the service:

(a) is provided:

(i) during a home visit to a person; or

(ii) in a residential aged care facility; or

(iii) in an institution; and

(b) is provided to each of 2 patients at a single location on a single occasion; and

(c) is:

(i) bulk‑billed for the fees for this item and another item in the table applying to the service; or

(ii) not bulk‑billed for the fees for this item and another item in the table applying to the service

11.60

10933

A service to which an item in Group A10 applies (other than this item or item 10916, 10931, 10932, 10940 or 10941), if the service:

(a) is provided:

(i) during a home visit to a person; or

(ii) in a residential aged care facility; or

(iii) in an institution; and

(b) is provided to each of 3 patients at a single location on a single occasion; and

(c) is:

(i) bulk‑billed for the fees for this item and another item in the table applying to the service; or

(ii) not bulk‑billed for the fees for this item and another item in the table applying to the service

7.70

10940

Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:

(a) is not a service involving multifocal multichannel objective perimetry; and

(b) is performed by an optometrist;

other than a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies

63.75

10941

Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:

(a) is not a service involving multifocal multichannel objective perimetry; and

(b) is performed by an optometrist;

other than a service associated with a service to which item 10916, 10918 10931, 10932 or 10933 applies

38.45

10942

Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N.12 or worse in the better eye or a horizontal visual field of less than 120 degrees and within 10 degrees above and below the horizontal midline, involving one or more of the following:

(a) spectacle correction;

(b) determination of contrast sensitivity;

(c) determination of glare sensitivity;

(d) prescription of magnification aids;

other than a service associated with a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

33.45

10943

Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant binocular or accommodative dysfunction, in a patient aged 3 to 14 years, including assessment of one or more of the following:

(a) accommodation;

(b) ocular motility;

(c) vergences;

(d) fusional reserves;

(e) cycloplegic refraction;

other than a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies

33.45

Division 2.29Miscellaneous services

Note:       Reserved for future use.

Division 2.30Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

2.30.1  Definitions for item 10997

                   In item 10997:

GP management plan means a plan under item 721 or 732 (for coordination of a review of a GP management plan under item 721).

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

person with a chronic disease means a person who has a care plan under item 721, 723, 729, 731 or 732.

2.30.2  Application of item 10986

             (1)  For item 10986, the only health assessment that may be provided is a Healthy Kids Check, in accordance with clause 2.16.4 for a patient if the patient is:

                     (a)  at least 3 years old and under 5 years old; and

                     (b)  receiving or has received the immunisation recommended for a 4 year old child; and

                     (c)  not an in‑patient of a hospital.

             (2)  Item 10986 applies only if:

                     (a)  the practice nurse or Aboriginal and Torres Strait Islander health practitioner providing the assessment is appropriately qualified and trained to perform the services provided; and

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

             (3)  A Healthy Kids Check, in accordance with clause 2.16.4, provided under item 10986:

                     (a)  must not be provided more than once to an eligible person; and

                     (b)  must not be provided to a patient who has previously received a Healthy Kids Check, in accordance with clause 2.16.4, under item 701, 703, 705 or 707.

2.30.3  Restrictions on item 10986

             (1)  A health assessment mentioned in clause 2.30.2 must not include a health screening service.

             (2)  A separate consultation must not be conducted in conjunction with a health assessment unless clinically necessary.

             (3)  In this clause:

health screening service has the same meaning as in subsection 19(5) of the Act.

2.30.4  Application of item 10988

             (1)  Item 10988 applies to an immunisation provided to a person by an Aboriginal and Torres Strait Islander health practitioner only if:

                     (a)  the Aboriginal and Torres Strait Islander health practitioner is appropriately qualified and trained to provide immunisations to persons; and

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

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

2.30.5  Application of item 10989

                   Item 10989 applies to an Aboriginal and Torres Strait Islander health practitioner if:

                     (a)  the health practitioner is appropriately qualified and trained to treat wounds; and

                     (b)  a medical practitioner under whose supervision the health practitioner provides the treatment has conducted an initial assessment of the person; and

                     (c)  the health practitioner has been instructed by the medical practitioner about the treatment of the wound; and

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

2.30.6  Limitation of item 10983

                   Item 10983 does not apply if the patient or the specialist or consultant physician mentioned in paragraph (a) of the item travels to a place to satisfy the requirement in sub‑subparagraph (c)(i)(B) of the item.

 

Group M12—Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

Item

Description

Fee ($)

Subgroup 1—Video conferencing consultation support service provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

10983

Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner, to provide clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist, physician or psychiatrist mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

      for which a direction made under subsection 19(2) of the Act applies

32.40

Subgroup 2—Video conferencing consultation support service provided at a residential care service, on behalf of a medical practitioner

10984

Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner, to provide clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist; and

(b) is a care recipient in a residential care service; and

(c) is not a resident of a self‑contained unit

32.40

Subgroup 3—Services provided by a practice nurse or an Aboriginal and Torres
 Strait Islander health practitioner on behalf of a medical practitioner

10986

A Healthy Kids Check in accordance with clause 2.16.4 provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner for a patient who is receiving or has received the immunisation recommended for a 4 year old child if:

(a) the Healthy Kids Check is provided on behalf of, and under the supervision of, a medical practitioner (including a general practitioner, but not including a specialist or consultant physician); and

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

58.20

10987

Follow‑up service, to a maximum of 10 services per patient in a calendar year, provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health check if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

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

(c) the service is consistent with the needs identified through the health assessment

24.00

10988

Immunisation provided to a person by an Aboriginal and Torres Strait Islander health practitioner if:

(a) the immunisation is provided on behalf of, and under the supervision of, a medical practitioner; and

(b) the person is not an admitted patient of a hospital

12.00

10989

Treatment of a person’s wound (other than normal aftercare) provided by an Aboriginal and Torres Strait Islander health practitioner if:

(a) the treatment is provided on behalf of, and under the supervision of, a medical practitioner; and

(b) the person is not an admitted patient of a hospital

12.00

10997

Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic disease, to a maximum of 5 services for each patient in a calendar year, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

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

(c) the person has a GP management plan, team care arrangements or multidisciplinary care plan in place and the service is consistent with the plan or arrangements

12.00

Division 2.31Group M1: Management of bulk‑billed services

2.31.1  Definitions for Division 2.31

                   In this Division:

ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2010, published by the Australian Bureau of Statistics, as in force on 16 September 2010.

bulk‑billed, for a medical service, means:

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

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

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

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

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

eligible area means:

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

                     (b)  Tasmania; or

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

                              (i)  Beaudesert Shire Part A;

                             (ii)  Belconnen;

                            (iii)  Darwin City;

                            (iv)  Eastern Outer Melbourne;

                             (v)  East Metropolitan Perth;

                            (vi)  Frankston City;

                           (vii)  Gosford‑Wyong;

                          (viii)  Greater Geelong City Part A;

                            (ix)  Gungahlin‑Hall;

                             (x)  Ipswich City (Part in BSD);

                            (xi)  Litchfield Shire;

                           (xii)  Melton‑Wyndham;

                          (xiii)  Mornington Peninsula Shire;

                          (xiv)  Newcastle;

                           (xv)  North Canberra;

                          (xvi)  Palmerston‑East Arm;

                         (xvii)  Pine Rivers Shire;

                        (xviii)  Queanbeyan;

                          (xix)  South Canberra;

                           (xx)  South Eastern Outer Melbourne;

                          (xxi)  Southern Adelaide;

                         (xxii)  South West Metropolitan Perth;

                        (xxiii)  Thuringowa City Part A;

                        (xxiv)  Townsville City Part A;

                         (xxv)  Tuggeranong;

                        (xxvi)  Weston Creek‑Stromlo;

                       (xxvii)  Woden Valley;

                      (xxviii)  Yarra Ranges Shire Part A; or

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

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

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

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

2.31.2  Application of items 10990, 10991 and 10992

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

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

             (3)  If item 10990, 10991 or 10992 applies to a medical service, the fee mentioned in that item applies in addition to the fee mentioned in another item in the table that applies to the service.

 

Group M1—Management of bulk‑billed services

Item

Description

Fee ($)

10990

A medical service to which an item in the table (other than this item or item 10991 or 10992) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

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

(d) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item in the table applying to the service

7.20

10991

A medical service to which an item in the table (other than this item or item 10990 or 10992) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

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

(d) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item in the table applying to the service; and

(e) the service is provided at, or from, a practice location in an eligible area

10.85

10992

A medical service to which item 597, 598, 599, 600, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 or 5267 applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

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

(d) the service is not provided in consulting rooms; and

(e) the service is provided in an eligible area; and

(f) the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an eligible area; and

(g) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item in the table applying to the service

10.85

Division 2.33Diagnostic procedures and investigations

Note:       Reserved for future use.

Division 2.34Group D1: Miscellaneous diagnostic procedures and investigations

2.34.1  Meaning of report

                   In this Division:

report means a report prepared by a medical practitioner.

2.34.2  Meaning of qualified sleep medicine practitioner

             (1)  In items 12203, 12207, 12213 and 12217:

qualified sleep medicine practitioner means a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner.

          (1A)  In items 12210 and 12215:

qualified sleep medicine practitioner:

                     (a)  means a qualified paediatric sleep medicine practitioner; and

                     (b)  does not include a qualified adult sleep medicine practitioner.

       (1AA)  In item 12250:

qualified sleep medicine practitioner:

                     (a)  means a qualified adult sleep medicine practitioner; and

                     (b)  does not include a qualified paediatric sleep medicine practitioner.

             (2)  A person is a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner if:

                     (a)  the person has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, sufficient training and experience in the relevant field of sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; or

                     (b)  the person:

                              (i)  has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, substantial training or experience in adult sleep medicine, but requiring further specified training or experience in the relevant field of sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; and

                             (ii)  either:

                                        (A)  the period of 2 years immediately following that assessment has not expired; or

                                        (B)  the person has been assessed by the Credentialling Subcommittee as having satisfactorily finished the further training or gained the further experience specified for that person; or

                     (c)  the person has attained Level I or Level II of the relevant Advanced Training Program of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association, after having completed at least 12 months core training, including clinical practice in the relevant field of sleep medicine and in reporting sleep studies; or

                     (d)  the Advisory Committee has recognised the person, in writing, as having training equivalent to the training mentioned in paragraph (c).

             (3)  In this clause:

Advisory Committee means the Specialist Advisory Committee in Thoracic and Sleep Medicine of the Royal Australasian College of Physicians.

Appeal Committee means the Appeal Committee of the Royal Australasian College of Physicians.

Credentialling Subcommittee means the Credentialling Subcommittee of the Advisory Committee.

relevant Advanced Training Program means:

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

                     (b)  for an assessment for qualification as a qualified paediatric sleep medicine practitioner—the Advanced Training Program in Paediatric Sleep Medicine.

relevant field of sleep medicine means:

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

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

 

Group D1—Miscellaneous diagnostic procedures and investigations

Item

Description

Fee ($)

Subgroup 1—Neurology

11000

Electroencephalography, other than a service:

(a) associated with a service to which item 11003, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices (Anaes.)

123.10

11003

Electroencephalography, prolonged recording of at least 3 hours in duration, other than a service:

(a) associated with a service to which item 11000, 11004, 11005, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

325.70

11004

Electroencephalography, ambulatory or video, prolonged recording of at least 3 hours in duration up to 24 hours in duration, recording on the first day, other than a service:

(a) associated with a service to which item 11000, 11003, 11005, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

325.70

11005

Electroencephalography, ambulatory or video, prolonged recording of at least 3 hours in duration up to 24 hours in duration, recording on each day after the first day, other than a service:

(a) associated with a service to which item 11000, 11003, 11004, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

325.70

11006

Electroencephalography, temporosphenoidal, other than a service involving quantitative topographic mapping using neurometrics or similar devices

167.00

11009

Electrocorticography

227.75

11012

Neuromuscular electrodiagnosis—conduction studies on one nerve or electromyography of one or more muscles using concentric needle electrodes or both these examinations (other than a service associated with a service to which item 11015 or 11018 applies)

112.00

11015

Neuromuscular electrodiagnosis—conduction studies on 2 or 3 nerves with or without electromyography (other than a service associated with a service to which item 11012 or 11018 applies)

149.90

11018

Neuromuscular electrodiagnosis—conduction studies on 4 or more nerves with or without electromyography or recordings from single fibres of nerves and muscles or both of these examinations (other than a service associated with a service to which item 11012 or 11015 applies)

223.95

11021

Neuromuscular electrodiagnosis—repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis or both of these examinations

149.90

11024

Central nervous system evoked responses, investigation of, by computerised averaging techniques, other than a service involving quantitative topographic mapping of event‑related potentials or involving multifocal multichannel objective perimetry—one or 2 studies

113.85

11027

Central nervous system evoked responses, investigation of, by computerised averaging techniques, other than a service involving quantitative topographic mapping of event‑related potentials or involving multifocal multichannel objective perimetry—3 or more studies

168.90

Subgroup 2—Ophthalmology

11200

Provocative test or tests for open angle glaucoma, including water drinking

40.80

11204

Electroretinography of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards

108.25

11205

Electrooculography of one or both eyes performed according to current professional guidelines or standards

108.25

11210

Pattern electroretinography of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards

108.25

11211

Dark adaptometry of one or both eyes with a quantitative estimation of threshold in log lumens at 45 minutes of dark adaptations

108.25

11215

Retinal photography, multiple exposures, of one eye with intravenous dye injection

123.00

11218

Retinal photography, multiple exposures of both eyes with intravenous dye injection

151.95

11221

Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral—to a maximum of 2 examinations (including examinations to which item 11224 applies) in any 12 month period

67.75

11222

Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, bilateral, if it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11221 applies due to presence of one of the following conditions:

(a) established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;

(b) established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;

(c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;

each additional examination

67.75

11224

Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral—to a maximum of 2 examinations (including examinations to which item 11221 applies) in any 12 month period

40.85

11225

Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, unilateral, if it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11224 applies due to presence of one of the following conditions:

(a) established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;

(b) established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;

(c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;

each additional examination

40.85

11235

Examination of the eye by impression cytology of cornea for the investigation of ocular surface dysplasia, including the collection of cells, processing and all cytological examinations and preparation of report

122.75

11237

Ocular contents, simultaneous ultrasonic echography by both unidimensional and bidimensional techniques, for the diagnosis, monitoring or measurement of choroidal and ciliary body melanomas, retinoblastoma or suspicious naevi or simulating lesions, one eye, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

81.45

11240

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of one eye before lens surgery on that eye, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

81.45

11241

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for bilateral eye measurement before lens surgery on both eyes, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

103.65

11242

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of an eye previously measured and on which lens surgery has been performed, and if further lens surgery is contemplated in that eye, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

80.10

11243

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of a second eye if:

(a) surgery for the first eye has resulted in more than one dioptre of error; or

(b) more than 3 years have elapsed since the surgery for the first eye;

other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

80.10

11244

Orbital contents, diagnostic B‑scan of, by a specialist practising in his or her specialty of ophthalmology, not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

77.00

Subgroup 3—Otolaryngology

11300

Brain stem evoked response audiometry (Anaes.)

192.45

11303

Electrocochleography, extratympanic method, one or both ears

192.45

11304

Electrocochleography, transtympanic membrane insertion technique, one or both ears

316.95

11306

Non‑determinate audiometry

21.90

11309

Audiogram, air conduction

26.30

11312

Audiogram, air and bone conduction or air conduction and speech discrimination

37.15

11315

Audiogram, air and bone conduction and speech

49.20

11318

Audiogram, air and bone conduction and speech, with other cochlear tests

60.75

11321

Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff’s test)

115.35

11324

Impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of his or her specialty, if the patient is referred by a medical practitioner—other than a service associated with a service to which item 11309, 11312, 11315 or 11318 applies

32.85

11327

Impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of his or her specialty, if the patient is referred by a medical practitioner—being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies

19.75

11330

Impedance audiogram if the patient is not referred by a medical practitioner—one examination in any 4 week period

7.90

11332

Oto‑acoustic emission audiometry for the detection of permanent congenital hearing impairment, performed by or on behalf of a specialist or consultant physician, on an infant or child in circumstances in which:

(a) the patient is referred to a specialist or consultant physician by a medical practitioner; and

(b) the specialist or consultant physician has given an opinion that excludes middle ear pathology for the patient; and

(c) the patient is at risk due to one or more of the following factors:

(i) admission to a neonatal intensive care unit;

(ii) family history of hearing impairment;

(iii) intra‑uterine or perinatal infection (either suspected or confirmed);

(iv) birthweight less than 1.5 kg;

(v) craniofacial deformity;

(vi) birth asphyxia;

(vii) chromosomal abnormality, including Down Syndrome;

(viii) exchange transfusion

58.55

11333

Caloric test of labyrinth or labyrinths

44.60

11336

Simultaneous bithermal caloric test of labyrinths

44.60

11339

Electronystagmography

44.60

Subgroup 4—Respiratory

11500

Bronchospirometry, including gas analysis

167.00

11503

Measurement of the:

(a) mechanical or gas exchange function of the respiratory system; or

(b) respiratory muscle function; or

(c) ventilatory control mechanisms

Various measurement parameters may be used including any of the following:

(a) pressures;

(b) volumes;

(c) flow;

(d) gas concentrations in inspired or expired air;

(e) alveolar gas or blood;

(f) electrical activity of muscles

The tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital. Each occasion at which one or more of such tests are performed, not being a service associated with a service to which item 22018 applies

138.65

11506

Measurement of respiratory function involving a permanently recorded tracing performed before and after inhalation of bronchodilator—each occasion at which one or more such tests are performed

20.55

11509

Measurement of respiratory function involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex respiratory function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital)—each occasion at which one or more such tests are performed

35.65

11512

Continuous measurement of the relationship between flow and volume during expiration or inspiration involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex lung function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital)—each occasion at which one or more such tests are performed

61.75

Subgroup 5—Vascular

11600

Central venous, pulmonary arterial, systemic arterial or cardiac intracavity blood pressure monitoring by indwelling catheter—once only for each type of pressure for a patient on a calendar day, other than a service:

(a) associated with the management of general anaesthesia; and

(b) to which item 13876 applies

69.30

11602

Investigation of venous reflux or obstruction in one or more limbs at rest by CW Doppler or pulsed Doppler involving examination at multiple sites along each limb using intermittent limb compression or Valsalva manoeuvres, or both, to detect prograde and retrograde flow, other than a service associated with a service to which item 32500 or 32501 applies—hard copy trace and written report, the report component of which must be performed by a medical practitioner, maximum of 2 examinations in a 12 month period, not to be used in conjunction with sclerotherapy

57.75

11604

Investigation of chronic venous disease in the upper and lower extremities, one or more limbs, by plethysmography (excluding photoplethysmography)—examination, hard copy trace and written report, not being a service associated with a service to which item 32500 or 32501 applies

75.70

11605

Investigation of complex chronic lower limb reflux or obstruction, in one or more limbs, by infrared photoplethysmography, during and following exercise to determine surgical intervention or the conservative management of deep venous thrombotic disease—hard copy trace, calculation of 90% recovery time and written report, not being a service associated with a service to which item 32500 or 32501 applies

75.70

11610

Measurement of ankle—brachial indices and arterial waveform analysis, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of lower extremity arterial disease—examination, hard copy trace and report

63.75

11611

Measurement of wrist—brachial indices and arterial waveform analysis, measurement of radial and ulnar (or finger) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of the wrist (or finger) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of upper extremity arterial disease—examination, hard copy trace and report

63.75

11612

Exercise study for the evaluation of lower extremity arterial disease, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices for the evaluation of lower extremity arterial disease at rest and following exercise using a treadmill or bicycle ergometer or other such equipment, if the exercise workload is quantifiably documented—examination and report

112.40

11614

Transcranial doppler, examination of the intracranial arterial circulation using CW Doppler or pulsed Doppler with hard copy recording of waveforms, examination and report, other than a service associated with a service to which item 55229 or 55280 of the diagnostic imaging services table applies

75.70

11615

Measurement of digital temperature, one or more digits, (unilateral or bilateral) and report, with hard copy recording of temperature before and for 10 minutes or more after cold stress testing

75.90

11627

Pulmonary artery pressure monitoring during open heart surgery, in a person under 12 years of age

228.65

Subgroup 6—Cardiovascular

11700

Twelve‑lead electrocardiography, tracing and report

31.25

11701

Twelve‑lead electrocardiography, report only if the tracing has been forwarded to another medical practitioner, not in association with a consultation on the same occasion

15.55

11702

Twelve‑lead electrocardiography, tracing only

15.55

11708

Continuous ECG recording of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in association with ambulatory blood pressure monitoring, involving microprocessor based analysis equipment, interpretation and report of recordings by a specialist physician or consultant physician

Not being a service to which item 11709 applies

The changing of a tape or batteries does not constitute a separate service. Where a recording is analysed and reported on and a decision is made to undertake a further period of monitoring, the second episode is regarded as a separate service

127.90

11709

Continuous ECG recording (Holter) of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in association with ambulatory blood pressure monitoring, utilising a system capable of superimposition and full disclosure printout of at least 12 hours of recorded ECG data, microprocessor based scanning analysis, with interpretation and report by a specialist physician or consultant physician

The changing of a tape or batteries does not constitute a separate service. Where a recording is analysed and reported on and a decision is made to undertake a further period of monitoring, the second episode is regarded as a separate service

167.45

11710

Ambulatory ECG monitoring, patient activated, single or multiple event recording, utilising a looping memory recording device which is connected continuously to the patient for 12 hours or more and is capable of recording for at least 20 seconds before each activation and for 15 seconds after each activation, including transmission, analysis, interpretation and report—payable once in any 4 week period

51.90

11711

Ambulatory ECG monitoring for 12 hours or more, patient activated, single or multiple event recording, utilising a memory recording device which is capable of recording for at least 30 seconds after each activation, including transmission, analysis, interpretation and report—payable once in any 4 week period

28.30

11712

Multi channel ECG monitoring and recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, involving the continuous attendance of a medical practitioner for not less than 20 minutes, with resting ECG, and with or without continuous blood pressure monitoring and the recording of other parameters, on premises equipped with mechanical respirator and defibrillator

152.15

11713

Signal averaged ECG recording involving not more than 300 beats, using at least 3 leads with data acquisition at not less than 1000Hz of at least 100 QRS complexes, including analysis, interpretation and report of recording by a specialist physician or consultant physician

69.75

11715

Blood dye—dilution indicator test

120.75

11718