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Determinations/Health as made
This determination introduces 4 new MBS items to the GMST for the purpose of injecting IncobotulinumtoxinA.
Administered by: Health
General Comments: This Determination ceases to have effect at 23:59, 30 June 2015.
Registered 01 Apr 2015
Tabling HistoryDate
Tabled Senate11-May-2015
Tabled HR12-May-2015
Table of contents.

Health Insurance (IncobotulinumtoxinA) Determination 2015

 

I,  KIRSTY FAICHNEY, delegate of the Minister for Health, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.

 

Dated 27 March 2015

 

 

__________________________

 

KIRSTY FAICHNEY

ACTING FIRST ASSISTANT SECRETARY

MEDICAL BENEFITS DIVISION

 

 

 

 


Contents

 

1.                      Name of Determination                                                                             3

2.                      Commencement                                                                                       3

3.                      Cessation                                                                                                3

4.                      Authority                                                                                                 3

5.                      Interpretation                                                                                           3

6.                      Treatment of a relevant service                                                                   4

7.                      Limitation on services                                                                                4

SCHEDULE              SPECIFIED HEALTH SERVICES                                                             5

 

 


Part 1                     Preliminary

1.                       Name of Determination

This Determination is the Health Insurance (IncobotulinumtoxinA) Determination 2015.

2.                       Commencement

This Determination commences on 1 April 2015.

3.                       Cessation

This Determination ceases to have effect at 23:59, 30 June 2015.

4.           Authority

This Determination is made under the Health Insurance Act 1973.

5.           Interpretation

(1)    In this Determination:

         Act means the Health Insurance Act 1973.

general medical services table means the table prescribed under subsection 4(1) of the Act.

relevant provision means a provision of the Act or of regulations made under the Act, or a provision of the National Health Act 1953 or of regulations made under that Act, that relates to professional services, medical services or items.

relevant service means a health service, as defined in subsection 3C(8)

of the Act, that is specified in the Schedule.

 

Schedule means the Schedule to this Determination.

 

Note     Unless the contrary intention appears, expressions used in this determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.

(2)    Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act or the National Health Act 1953 or regulations made under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

6.           Treatment of a relevant service

              A relevant service specified in the Schedule shall, for the purposes of each relevant provision, be treated as if:

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

(b)                   there were an item in Group T11 of the general medical services table that:

i.         related to the service; and

ii.        specified in respect of the service a fee in relation to each State being the fee specified in the Schedule.

7.           Specification of relevant services

The provisions of the general medical services table mentioned in column 1 of the following table shall be taken to have effect as if the items mentioned in column 2 of the table were also specified in the provision:

 

Column 1

Column 2

Subclause 1.2.4(1)

18353, 18365, 18369, 18374

Subclause 1.2.5(1)

18353, 18365, 18369, 18374

Subclause 2.42A.1(1)

18353, 18369, 18374

Subclause 2.42A.1(2)

18353, 18365, 18369, 18374

Clause 2.42A.2

18365

Item 18360, paragraph (e)

18365

 

 

 


SCHEDULE    SPECIFIED HEALTH SERVICES

 

Item

Description

Fee($) (all States)

18353

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin-Haemagglutin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of cervical dystonia (spasmodic torticollis), including all such injections on any one day

249.75

18365

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin-Haemagglutin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of moderate to severe spasticity of the upper limb following a stroke, if:

(a) the patient is at least 18 years of age; and

(b) treatment is provided as:

(i) second line therapy when standard treatment for the condition has failed; or

(ii) an adjunct to physical therapy; and

(c) the patient does not have established severe contracture in the limb that is to be treated; and

(d) the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve, with a maximum of 4 sets of injections for the patient on any one day (with a maximum of 2 sets of injections for each upper limb), including all injections per set; and

(e) for a patient who has received treatment on 2 previous separate occasions - the patient has responded to the treatment

124.85

 



18369

Clostridium Botulinum Type A Toxin-Haemagglutin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of unilateral blepharospasm in a patient who is at least 18 years of age, including all such injections on any one day (Anaes.)

45.05

18374

Clostridium Botulinum Type A Toxin-Haemagglutin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of bilateral blepharospasm in a patient who is at least 18 years of age, including all such injections on any one day (Anaes.)

124.85