Federal Register of Legislation - Australian Government

Primary content

Regulations as made
These regulations amend multiple regulations to implement the Government’s response to recommendations from the Medical Services Advisory Committee and the clinician-led Medicare Benefits Schedule Review Taskforce.
Administered by: Health
Registered 24 Sep 2019
Tabling HistoryDate
Tabled HR14-Oct-2019
Tabled Senate14-Oct-2019
To be repealed 02 Jan 2020
Repealed by Division 1 of Part 3 of Chapter 3 of the Legislation Act 2003
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019

I, General the Honourable David Hurley AC DSC (Retd), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.

Dated 19 September 2019

David Hurley

Governor‑General

By His Excellency’s Command

Greg Hunt

Minister for Health

 

 

 

 

  

  


Contents

1............ Name............................................................................................................................. 1

2............ Commencement............................................................................................................. 1

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

4............ Schedules...................................................................................................................... 1

Schedule 1—Amendments commencing 1 November 2019                                                    2

Part 1—Medical practitioner video conferencing consultations                                        2

Health Insurance (General Medical Services Table) Regulations 2019                                     2

Part 2—Breast cancer services                                                                                                            4

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019                               4

Part 3—Radiology services for patients in residential aged care facilities                   6

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019                               6

Part 4—Colonoscopy services                                                                                                             7

Health Insurance (General Medical Services Table) Regulations 2019                                     7

Part 5—Anaesthesia services                                                                                                               9

Health Insurance (General Medical Services Table) Regulations 2019                                     9

Part 6—Administrative review                                                                                                         14

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019                             14

Part 7—Miscellaneous amendments                                                                                              15

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019                             15

Health Insurance (General Medical Services Table) Regulations 2019                                   15

Health Insurance Regulations 2018                                                                                                18

Schedule 2—Amendments commencing 1 January 2020                                                      19

Part 1—After‑hours services                                                                                                              19

Health Insurance (General Medical Services Table) Regulations 2019                                   19

Part 2—Bulk‑billing                                                                                                                               20

Health Insurance (General Medical Services Table) Regulations 2019                                   20

 


1  Name

                   This instrument is the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019.

2  Commencement

             (1)  Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  Sections 1 to 4 and anything in this instrument not elsewhere covered by this table

The day after this instrument is registered.

25 September 2019

2.  Schedule 1

1 November 2019.

1 November 2019

3.  Schedule 2

1 January 2020.

1 January 2020

Note:          This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

             (2)  Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

                   This instrument is made under the Health Insurance Act 1973.

4  Schedules

                   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.

Schedule 1Amendments commencing 1 November 2019

Part 1Medical practitioner video conferencing consultations

Health Insurance (General Medical Services Table) Regulations 2019

1  Subclause 1.2.5(1) of Schedule 1

Omit “2220”, substitute “2478”.

2  Paragraph 1.2.5(3)(c) of Schedule 1

After “2220,”, insert “2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478,”.

3  Paragraph 1.2.6(4)(c) of Schedule 1

After “2220,”, insert “2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478,”.

4  After clause 2.20.4 of Schedule 1

Insert:

2.20.5  Limitation of items in Subgroups 5 and 6 of Group A30 (video conferencing consultation attendances for patients in rural and remote areas)

             (1)  An item in Subgroup 5 or 6 of Group A30 applies to a professional attendance on a patient by a medical practitioner only if:

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

                     (b)  the patient is located within a Modified Monash 6 area or a Modified Monash 7 area; and

                     (c)  at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other; and

                     (d)  the patient has received 3 face‑to‑face professional attendances from that practitioner in the preceding 12 months.

             (2)  An item in Subgroup 5 or 6 of Group A30 does not apply if the patient or the medical practitioner travels to a place to satisfy the requirement in paragraph (1)(c).

5  Schedule 1 (Group A30 table, at the end of the table)

Add:

 

Subgroup 5—General practitioner video conferencing consultation attendance for patients in rural and remote areas

2461

Professional attendance by video conference 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

17.50

2463

Professional attendance by video conference by a general practitioner, of less than 20 minutes in duration, 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

38.20

2464

Professional attendance by video conference by a general practitioner, of at least 20 minutes in duration but less than 40 minutes, 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

73.95

2465

Professional attendance by video conference by a general practitioner, of at least 40 minutes in duration, 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

108.85

Subgroup 6—Other non‑referred video conferencing consultation attendance for patients in rural and remote areas

2471

Professional attendance by video conference of not more than 5 minutes in duration by a medical practitioner who is not a general practitioner—each attendance

11.00

2472

Professional attendance by video conference of more than 5 minutes in duration but not more than 25 minutes by a medical practitioner who is not a general practitioner—each attendance

21.00

2475

Professional attendance by video conference of more than 25 minutes in duration but not more than 45 minutes by a medical practitioner who is not a general practitioner—each attendance

38.00

2478

Professional attendance by video conference of more than 45 minutes in duration by a medical practitioner who is not a general practitioner—each attendance

61.00

Part 2Breast cancer services

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019

6  Schedule 1 (after item 61523)

Insert:

 

61524

Whole body FDG PET study, performed for the staging of locally advanced (Stage III) breast cancer, for a patient who is considered suitable for active therapy (R)

953.00

61525

Whole body FDG PET study, performed for the evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma, for a patient who is considered suitable for active therapy (R)

953.00

7  Schedule 1 (items 63487 to 63490)

Repeal the items, substitute:

 

63487

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and

(ii) clinical examination and conventional imaging have failed to identify the primary cancer (R) (K) (Anaes.)

690.00

63488

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and

(ii) clinical examination and conventional imaging have failed to identify the primary cancer (R) (NK) (Anaes.)

345.00

63489

MRI—guided biopsy, if:

(a) the request for the scan identifies that the patient has a suspicious lesion seen on MRI but not on conventional imaging; and

(b) an ultrasound scan of the affected breast, performed immediately before the biopsy, confirms that the lesion is not amenable to biopsy guided by conventional imaging; and

(c) a dedicated breast coil is used (R) (K) (Anaes.)

1440.00

63490

MRI—guided biopsy, if:

(a) the request for the scan identifies that the patient has a suspicious lesion seen on MRI but not on conventional imaging; and

(b) an ultrasound scan of the affected breast, performed immediately before the biopsy, confirms that the lesion is not amenable to biopsy guided by conventional imaging; and

(c) a dedicated breast coil is used (R) (NK) (Anaes.)

720.00

63531

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has a breast lesion; and

(ii) the results of conventional imaging are inconclusive for the presence of breast cancer; and

(iii) biopsy has not been possible (R) (K) (Anaes.) (Contrast)

690.00

63532

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has a breast lesion; and

(ii) the results of conventional imaging are inconclusive for the presence of breast cancer; and

(iii) biopsy has not been possible (R) (NK) (Anaes.) (Contrast)

345.00

63533

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has been diagnosed with a breast cancer; and

(ii) there is a discrepancy between the clinical assessment and the conventional imaging assessment of the extent of the malignancy; and

(c) the results of breast MRI imaging may alter treatment planning (R) (K) (Anaes.) (Contrast)

690.00

63534

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has been diagnosed with a breast cancer; and

(ii) there is a discrepancy between the clinical assessment and the conventional imaging assessment of the extent of the malignancy; and

(c) the results of breast MRI imaging may alter treatment planning (R) (NK) (Anaes.) (Contrast)

345.00

Part 3Radiology services for patients in residential aged care facilities

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019

8  At the end of Subdivision A of Division 2.3 of Schedule 1

Add:

2.3.2A  Increased fee for service rendered using first eligible X‑ray procedure carried out during attendance at residential aged care facility

             (1)  This clause applies if:

                     (a)  a person attends a residential aged care facility; and

                     (b)  during the attendance, the person carries out one or more eligible X‑ray procedures on one or more patients who are care recipients in the facility.

             (2)  The fee for the service that is rendered using the first eligible X‑ray service carried out during the attendance is the amount listed in the item that applies to the service plus $73.65.

9  Clause 3.1 of Schedule 1

Insert:

care recipient has the meaning given by the general medical services table.

eligible X‑ray procedure means a diagnostic imaging procedure used in rendering a service to which item 57509, 57515, 57521, 57527, 57530, 57533, 57536, 57539, 57703, 57705, 57709, 57711, 57712, 57714, 57715, 57717, 58503, 58505, 58521, 58523, 58524, 58526, 58527, 58529, 58903 or 58905 applies.

residential aged care facility has the meaning given by the general medical services table.

Part 4Colonoscopy services

Health Insurance (General Medical Services Table) Regulations 2019

10  Clause 2.46.14 of Schedule 1 (heading)

Omit “, 32087, 32090 and 32093”, substitute “and 32087”.

11  Clause 2.46.14 of Schedule 1

Omit “, 32087, 32090 or 32093”, substitute “or 32087”.

12  Schedule 1 (items 32084 and 32087, column 2)

Omit “item 32090 or 32093”, substitute “any of items 32222 to 32228”.

13  Schedule 1 (items 32088, 32089, 32090 and 32093)

Repeal the items.

14  Schedule 1 (after item 32221)

Insert:

 

32222

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) following a positive faecal occult blood test; or

(b) who has symptoms consistent with pathology of the colonic mucosa; or

(c) who has anaemia or iron deficiency; or

(d) for whom diagnostic imaging has shown an abnormality of the colon; or

(e) who is undergoing the first examination following surgery for colorectal cancer; or

(f) who is undergoing pre‑operative evaluation; or

(g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(h) for the management of inflammatory bowel disease

Applicable only once on a day under a single episode of anaesthesia or other sedation (Anaes.)

339.70

32223

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) who has had a colonoscopy that revealed 1 to 4 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(b) who has a moderate risk of colorectal cancer due to family history; or

(c) who has a history of colorectal cancer and has had an initial post‑operative colonoscopy that did not reveal any adenomas or colorectal cancer

Applicable only once in any 5‑year period (Anaes.)

339.70

32224

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a moderate risk of colorectal cancer due to:

(a) a history of adenomas, including an adenoma that:

(i) was greater than 10 mm in diameter; or

(ii) had villous features; or

(iii) had high grade dysplasia; or

(iv) was an advanced serrated adenoma; or

(b) having had a previous colonoscopy that revealed 5 to 9 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia

Applicable only once in any 3‑year period (Anaes.)

339.70

32225

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to having had a previous colonoscopy that:

(a) revealed 10 or more adenomas; or

(b) included a piecemeal, or possibly incomplete, excision of a large, sessile polyp

Applicable not more than 4 times in any 12‑month period (Anaes.)

339.70

32226

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to:

(a) a known or suspected familial condition, such as familial adenomatous polyposis, Lynch syndrome or serrated polyposis syndrome; or

(b) a genetic mutation associated with hereditary colorectal cancer

Applicable only once in any 12‑month period (Anaes.)

339.70

32227

Endoscopic examination of the colon to the caecum by colonoscopy:

(a) for the treatment of bleeding, including one or more of the following:

(i) radiation proctitis;

(ii) angioectasia;

(iii) post‑polypectomy bleeding; or

(b) for the treatment of colonic strictures with balloon dilatation

Applicable only once on a day under a single episode of anaesthesia or other sedation (Anaes.)

476.70

32228

Endoscopic examination of the colon to the caecum by colonoscopy, other than a service to which item 32222, 32223, 32224, 32225 or 32226 applies

Applicable only once (Anaes.)

339.70

32229

Removal of one or more polyps during colonoscopy, in association with a service to which item 32222, 32223, 32224, 32225, 32226 or 32228 applies (Anaes.)

274.00

Part 5Anaesthesia services

Health Insurance (General Medical Services Table) Regulations 2019

15  Schedule 1 (item 11507, column 2)

Omit “, 11512 or 22018”, substitute “or 11512”.

16  Schedule 1 (item 11508, column 2, subparagraph (a)(iv))

Omit “peri‑operative”, substitute “perioperative”.

17  Schedule 1 (item 11512, column 2)

Omit “, 11507 or 22018”, substitute “or 11507”.

18  Schedule 1 (items 18216, 18219, 18226 and 18227, column 2)

After “Intrathecal”, insert “, combined spinal‑epidural”.

19  Schedule 1 (after item 18296)

Insert:

 

18297

Assistance at the administration of an epidural blood patch (a service to which item 18233 applies) by another medical practitioner

60.30

20  Subclause 2.45.1(1) of Schedule 1 (paragraph (d) of the definition of amount under clause 2.45.1)

Omit “22001”, substitute “22002”.

21  Subclause 2.45.1(2) of Schedule 1 (paragraph (d) of the definition of amount under clause 2.45.1)

Omit “22001”, substitute “22002”.

22  Subclause 2.45.1(3) of Schedule 1 (paragraph (d) of the definition of amount under clause 2.45.1)

Omit “22001”, substitute “22002”.

23  Clause 2.45.2 of Schedule 1 (paragraph (d) of the definition of amount under clause 2.45.2)

Omit “22001”, substitute “22002”.

24  Schedule 1 (item 20142, column 3)

Omit “120.60”, substitute “100.50”.

25  Schedule 1 (items 20144 and 20145, column 3)

Omit “160.80”, substitute “140.70”.

26  Schedule 1 (item 20160, column 2)

After “for”, insert “intranasal”.

27  Schedule 1 (item 20162, column 2)

Omit “radical surgery on the nose and accessory sinuses”, substitute “intranasal surgery for malignancy or for intranasal ablation”.

28  Schedule 1 (item 20410, column 3)

Omit “100.50”, substitute “80.40”.

29  Schedule 1 (item 20705)

Repeal the item.

30  Schedule 1 (item 20706, column 2)

After “abdomen,”, insert “including laparoscopic cholecystectomy,”.

31  Schedule 1 (items 20745 and 20750)

Repeal the items, substitute:

 

20745

Initiation of the management of anaesthesia for either or both of the following:

(a) upper gastrointestinal endoscopic procedures in association with acute gastrointestinal haemorrhage;

(b) endoscopic retrograde cholangiopancreatography

140.70

20750

Initiation of the management of anaesthesia for hernia repairs to the upper abdominal wall, other than a service to which another item in this Subgroup applies

100.50

32  Schedule 1 (item 20790)

Repeal the item, substitute:

 

20790

Initiation of the management of anaesthesia for procedures within the peritoneal cavity in the upper abdomen, including any of the following:

(a) open cholecystectomy;

(b) gastrectomy;

(c) laparoscopic assisted nephrectomy;

(d) bowel shunts

160.80

33  Schedule 1 (item 20805)

Repeal the item.

34  Schedule 1 (item 20840, column 2)

Omit “procedures within the peritoneal cavity in lower abdomen”, substitute “open procedures within the peritoneal cavity in the lower abdomen”.

35  Schedule 1 (item 20902, column 2)

Omit “(including endoscopy or biopsy, or both)”, substitute “(including surgical haemorrhoidectomy, but not banding of haemorrhoids)”.

36  Schedule 1 (item 20953)

Repeal the item.

37  Schedule 1 (item 21922, column 3)

Omit “140.70”, substitute “120.60”.

38  Schedule 1 (item 21926, column 3)

Omit “100.50”, substitute “80.40”.

39  Schedule 1 (item 21927)

Repeal the item.

40  Schedule 1 (item 21936, column 3)

Omit “120.60”, substitute “100.50”.

41  Schedule 1 (item 21952)

Repeal the item, substitute:

 

21952

Initiation of the management of anaesthesia for diagnostic muscle biopsy to assess for malignant hyperpyrexia

80.40

42  Schedule 1 (item 22001)

Repeal the item.

43  Schedule 1 (item 22002, column 2)

After “Administration of”, insert “homologous”.

44  Schedule 1 (items 22012 and 22014)

Repeal the items, substitute:

 

22012

Monitoring that:

(a) is of one of the following types of blood pressure:

(i) central venous blood pressure;

(ii) pulmonary arterial blood pressure;

(iii) systemic arterial blood pressure;

(iv) cardiac intracavity blood pressure; and

(b) is conducted by indwelling catheter; and

(c) is performed in association with the administration of anaesthesia for a procedure and not as a service to which item 13876 applies; and

(d) is performed, on a day, on a patient who:

(i) is categorised as having a high risk of complications; or

(ii) during the procedure develops either complications or a high risk of complications; and

(e) has not previously been performed in those circumstances on the day on the patient for that type of blood pressure

60.30

22014

Monitoring that:

(a) is of one of the following types of blood pressure:

(i) central venous blood pressure;

(ii) pulmonary arterial blood pressure;

(iii) systemic arterial blood pressure;

(iv) cardiac intracavity blood pressure; and

(b) is conducted by indwelling catheter; and

(c) is performed in association with the administration of anaesthesia for a procedure (the current procedure) and not as a service to which item 13876 applies; and

(d) is performed, on a day, on a patient:

(i) who is categorised as having a high risk of complications or develops during the current procedure either complications or a high risk of complications; and

(ii) for whom monitoring of that type of blood pressure to which item 22012 applies has already been performed on the day in association with the administration of anaesthesia for another discrete procedure; and

(e) has not previously been performed in association with the current procedure for that type of blood pressure

60.30

45  Schedule 1 (item 22018)

Repeal the item.

46  Schedule 1 (item 22025)

Repeal the item, substitute:

 

22025

Intra‑arterial cannulation when performed in association with the management of anaesthesia for a procedure for a patient who:

(a) is categorised as having a high risk of complications; or

(b) develops a high risk of complications during the procedure

80.40

47  Schedule 1 (items 22031 and 22036, column 2)

Omit “post operative”, substitute “post‑operative”.

48  Schedule 1 (items 22040, 22045 and 22050)

Repeal the items, substitute:

 

22041

Introduction of a plexus or nerve block proximal to the lower leg or forearm, perioperatively performed in the induction room, theatre or recovery room, for post‑operative pain management

40.20

22042

Introduction of a regional or field nerve block performed via retrobulbar, peribulbar or sub‑Tenon’s block injection of an anaesthetic agent, or other complex eye block, when administered by an anaesthetist perioperatively

20.10

49  Schedule 1 (item 22070)

Repeal the item.

50  Schedule 1 (items 23021, 23022, 23023, 23031, 23032, 23033, 23041, 23042, 23043, 23051, 23052, 23053, 23061, 23062, 23063, 23071, 23072, 23073, 23081, 23082 and 23083)

Repeal the items, substitute:

 

23025

Anaesthesia, perfusion or assistance, if the service time is more than 15 minutes but not more than 30 minutes

40.20

23035

Anaesthesia, perfusion or assistance, if the service time is more than 30 minutes but not more than 45 minutes

60.30

23045

Anaesthesia, perfusion or assistance, if the service time is more than 45 minutes but not more than 1 hour

80.40

23055

Anaesthesia, perfusion or assistance, if the service time is more than 1 hour but not more than 1:15 hours

100.50

23065

Anaesthesia, perfusion or assistance, if the service time is more than 1:15 hours but not more than 1:30 hours

120.60

23075

Anaesthesia, perfusion or assistance, if the service time is more than 1:30 hours but not more than 1:45 hours

140.70

23085

Anaesthesia, perfusion or assistance, if the service time is more than 1:45 hours but not more than 2:00 hours

160.80

51  Schedule 1 (item 25015, column 2)

Omit “patient’s age is less than 12 months or is 70 years or more”, substitute “patient is aged not more than 3 years or at least 75 years”.

52  Schedule 1 (item 33845, column 2)

Omit “post operative”, substitute “post‑operative”.

53  Schedule 1 (item 50330, column 2)

Omit “post operative”, substitute “post‑operative”.

Part 6Administrative review

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019

54  At the end of subclause 1.2.3(3) of Schedule 1

Add:

               ; or (d)  the Secretary has given the relevant proprietor written notice of the Secretary’s decision under clause 1.2.4 to affirm a decision to refuse to grant an exemption under subclause (4) of this clause, and:

                              (i)  if an application for review has not been made under clause 1.2.4A—the time for making an application for review has not expired; or

                             (ii)  if an application for review has been made under clause 1.2.4A—each party to the proceeding has not been given a copy of the decision of the Administrative Appeals Tribunal on review.

Note:          For the time for making an application for review, see paragraph 29(1)(d) and subsection 29(2) of the Administrative Appeals Tribunal Act 1975.

55  After clause 1.2.4 of Schedule 1

Insert:

1.2.4A  Review of reconsideration decisions by Administrative Appeals Tribunal

                   Applications may be made to the Administrative Appeals Tribunal for review of decisions of the Secretary under clause 1.2.4, made on or after 1 November 2019, to affirm decisions to refuse to grant exemptions.

Part 7Miscellaneous amendments

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019

56  Clause 2.3.1 of Schedule 1

Repeal the clause, substitute:

2.3.1  Application of items in Subdivision B, D, E or G to services rendered using diagnostic imaging procedures carried out in metropolitan areas and certain inner regional areas

             (1)  This clause applies to a service described in an item in Subdivision B, D, E or G if the diagnostic imaging procedure used to render the service is carried out in an area other than:

                     (a)  an area that is RA2, RA3 or RA4; or

                     (b)  an area that is both:

                              (i)  RA1; and

                             (ii)  RRMA4 or RRMA5.

             (2)  The item applies to the service only if the procedure is carried out as permitted by subclause (3) or (4).

             (3)  For the purposes of subclause (2), the procedure used to render a service described in an item in Subdivision B, D, E or G may be carried out:

                     (a)  by a medical practitioner; or

                     (b)  by a person who is registered as a medical radiation practitioner under a law of a State or Territory, if the person carries out the procedure under the supervision of a medical practitioner in accordance with accepted medical practice.

             (4)  For the purposes of subclause (2), the procedure used to render a service described in an item in Subgroup 3 of Group I3 may also be carried out by a dental practitioner if the dental practitioner carries out the procedure under the supervision of a medical practitioner in accordance with accepted medical practice.

Health Insurance (General Medical Services Table) Regulations 2019

57  Clause 2.3.1 of Schedule 1

Repeal the clause.

58  Schedule 1 (items 52, 53, 54, 57, 58, 59, 60 and 65, column 2, paragraph (b))

Repeal the paragraph, substitute:

 

(b) a Group A1 disqualified general practitioner

59  Schedule 1 (items 90092, 90093, 90095 and 90096, column 2)

Omit all the words after “(subject to clause 2.31.1),”, substitute “by a medical practitioner who is not a general practitioner”.

60  Schedule 1 (item 12205, column 2, paragraph (a))

Repeal the paragraph, substitute:

 

(a) any of the following subparagraphs applies:

(i) there has been a recurrence of symptoms not explained by known or identifiable factors such as inadequate usage of treatment, sleep duration or significant recent illness;

(ii) there has been a significant change in weight or changes in co‑morbid conditions that could affect sleep‑related breathing disorders, and other means of assessing treatment efficacy (including review of data stored by a therapy device used by the patient) are unavailable or have been equivocal;

(iii) the patient has undergone a therapeutic intervention (including, but not limited to, positive airway pressure, upper airway surgery, positional therapy, appropriate oral appliance, weight loss of more than 10% in the previous 6 months or oxygen therapy), and there is either clinical evidence of sub‑optimal response or uncertainty about control of sleep‑disordered breathing; and

61  Schedule 1 (item 12207, column 2, paragraph (i))

Omit “cardio‑respiratory”, substitute “respiratory”.

62  Schedule 1 (items 30075 and 30078, column 2)

Omit “lymph gland”, substitute “lymph node”.

63  Schedule 1 (item 30275, column 2)

Omit “lymph glands”, substitute “lymph nodes”.

64  Schedule 1 (items 30329 and 30330, column 2)

Omit “Lymph glands”, substitute “Lymph nodes”.

65  Schedule 1 (items 35551, 35664 and 35670, column 2)

Omit “lymph glands”, substitute “lymph nodes”.

66  Schedule 1 (after item 41500)

Insert:

 

41501

Examination of glottal cycles and vibratory characteristics of the vocal folds, by a specialist in the practice of the specialist’s specialty of otolaryngology, using videostroboscopy (capturing audio, video, frequency and intensity), for confirmation of diagnosis, or for confirmation of treatment effectiveness where there is failure to progress or respond as expected, for:

(a) dysphonia, if non‑stroboscopic techniques of visualising the larynx have failed to identify any frank abnormality of the vocal folds; or

(b) benign vocal fold lesions; or

(c) premalignant or malignant laryngeal lesions; or

(d) vocal fold motion impairment or glottal insufficiency; or

(e) evaluation of vocal fold function after treatment or phonosurgery;

other than a service associated with a service to which item 41764 applies, or a service associated with the administration of a general anaesthetic

188.55

67  Schedule 1 (item 41846)

Repeal the item.

68  Schedule 1 (item 45626)

Repeal the item, substitute:

 

45626

Ectropion or entropion (due to causes other than trachoma), correction of (unilateral) (Anaes.)

331.25

45627

Ectropion or entropion (due to trachoma), correction of (unilateral) (Anaes.)

331.25

69  Clause 2.46.25 of Schedule 1 (heading)

Omit “51011 to 51171”, substitute “51011 to 51112 and 51115 to 51171”.

70  Clause 2.46.25 of Schedule 1

Omit “51011 to 51171”, substitute “51011 to 51112 and 51115 to 51171”.

71  Schedule 1 (items 51051, 51052 and 51053)

Repeal the items, substitute:

 

51051

Pedicle subtraction osteotomy, one vertebra, not being a service associated with a service to which item 51052, 51053, 51054, 51055, 51056, 51057, 51058 or 51059 applies (H) (Anaes.) (Assist.)

1,879.60

51052

Pedicle subtraction osteotomy, 2 vertebrae, not being a service associated with a service to which item 51051, 51053, 51054, 51055, 51056, 51057, 51058 or 51059 applies (H) (Anaes.) (Assist.)

2,286.00

51053

Vertebral column resection osteotomy performed through single posterior approach, one vertebra, not being a service associated with a service to which item 51051, 51052, 51054, 51055, 51056, 51057, 51058 or 51059 applies (H) (Anaes.) (Assist.)

2,600.95

72  Schedule 1 (items 51061 to 51066)

Omit “Spine fusion”, substitute “Spinal fusion”.

73  Schedule 1 (at the end of the cell at item 51145, column 2)

Add:

                (Assist.)

74  Schedule 1 (item 52027, column 2)

Omit “lymph gland”, substitute “lymph node”.

75  Clause 3.1 of Schedule 1

Insert:

Group A1 disqualified general practitioner means a general practitioner:

                     (a)  who is partly disqualified under an agreement that is in effect under section 92 of the Act in respect of a service to which an item in Group A1 applies; or

                     (b)  in relation to whom a final determination under section 106TA of the Act containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified is in effect in respect of a service to which an item in Group A1 applies.

76  Clause 3.1 of Schedule 1 (at the end of the definition of non‑medicare service)

Add:

                   ; (p)  extracorporeal magnetic innervation.

Health Insurance Regulations 2018

77  Subsection 28(1) (note)

Repeal the note, substitute:

Note:          Some services are specified in a determination made under subsection 3C(1) of the Act.

78  Subsection 28(1) (cell at table item 9, column 2)

Before “224,”, insert “177,”.

79  Subsection 28(1) (cell at table item 18, column 2)

Before “701,”, insert “699,”.

80  Subsection 28(1) (at the end of the cell at table item 28, column 2)

Add “, 2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478, 2480, 2481, 2482, 2483”.

81  Subsection 28(1) (after table item 28A)

Insert:

 

28B

A36

90250, 90251, 90252, 90253, 90254, 90255, 90256, 90257, 90264, 90265, 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281, 90282

Schedule 2Amendments commencing 1 January 2020

Part 1After‑hours services

Health Insurance (General Medical Services Table) Regulations 2019

1  Schedule 1 (item 591, column 3)

Omit “101.60”, substitute “91.45”.

Part 2Bulk‑billing

Health Insurance (General Medical Services Table) Regulations 2019

2  Clause 2.34.1 of Schedule 1

Insert:

designated area means the following:

                     (a)  a regional, rural or remote area;

                     (b)  Tasmania;

                     (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;

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

3  Clause 2.34.1 of Schedule 1 (definition of eligible area)

Repeal the definition, substitute:

eligible area means the following:

                     (a)  a Modified Monash 2 area;

                     (b)  a Modified Monash 3 area;

                     (c)  a Modified Monash 4 area;

                     (d)  a Modified Monash 5 area;

                     (e)  a Modified Monash 6 area;

                      (f)  a Modified Monash 7 area.

4  Schedule 1 (item 10992, column 2, paragraphs (g) and (h))

Omit “an eligible area”, substitute “a designated area”.

5  Clause 3.1 of Schedule 1 (definition of ASGS)

Repeal the definition, substitute:

ASGS means the July 2016 edition of the Australian Statistical Geography Standard, published by the Australian Bureau of Statistics, as existing on 1 January 2020.

Note:          The ASGS could in 2019 be viewed on the Australian Bureau of Statistics’ website (https://www.abs.gov.au).

6  Clause 3.1 of Schedule 1

Insert:

designated area, for Division 2.34, has the meaning given by clause 2.34.1.