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Regulations as made
This instrument amends the Health Insurance (General Medical Services Table) Regulations 2021 and Health Insurance Regulations 2018 to implement the Government’s response to recommendations from the MBS Review Taskforce (the Taskforce) regarding pain management, anaesthesia, and gynaecological services.
Administered by: Health
Registered 17 Dec 2021
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance Legislation Amendment (2021 Measures No. 4) Regulations 2021

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 16 December 2021

David Hurley

Governor‑General

By His Excellency’s Command

Greg Hunt

Minister for Health and Aged Care

 

 

 

  

  


Contents

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

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

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

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

Schedule 1—Amendments                                                                                                                          2

Part 1—General medical services                                                                                                      2

Health Insurance (General Medical Services Table) Regulations 2021                                     2

Part 2—Gynaecological services                                                                                                        9

Health Insurance (General Medical Services Table) Regulations 2021                                     9

Part 3——Miscellaneous amendments                                                                                         22

Division 1—Repeals of table items                                                                                                   22

Health Insurance (General Medical Services Table) Regulations 2021                                   22

Division 2—Consequential amendments                                                                                        23

Health Insurance (General Medical Services Table) Regulations 2021                                   23

Part 4—Medicare benefits                                                                                                                  24

Health Insurance Regulations 2018                                                                                                24

 


1  Name

                   This instrument is the Health Insurance Legislation Amendment (2021 Measures No. 4) Regulations 2021.

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.  The whole of this instrument

1 March 2022.

1 March 2022

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

Part 1General medical services

Health Insurance (General Medical Services Table) Regulations 2021

1  Schedule 1 (item 14209)

Repeal the item.

2  Schedule 1 (cell at item 14218, column 2)

Repeal the cell, substitute:

 

Implanted infusion pump, refilling of reservoir with a therapeutic agent or agents for infusion to the subarachnoid space or accessing the side port to assess catheter patency, with or without pump reprogramming, for the management of chronic pain, including cancer pain

3  Schedule 1 (item 18213, column 2)

After “perfusion”, insert “of local anaesthetic agent”.

4  Schedule 1 (items 18222 and 18225, column 2)

Omit “Infusion of a therapeutic substance”, substitute “Continuous infusion, or injection by catheter, of a therapeutic substance (not contrast agent)”.

5  Schedule 1 (item 18228, column 2)

After “substance”, insert “, not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach”.

6  Schedule 1 (item 18230, column 2)

After “substance”, insert “(not contrast agent) by any route, including transforaminal route”.

7  Schedule 1 (cell at item 18232, column 2)

Repeal the cell, substitute:

 

Intrathecal or epidural injection (including translaminar and transforaminal approaches) of therapeutic substance or substances (anaesthetic, steroid or chemotherapeutic agents):

(a) other than a service to which another item in this Group applies; and

(b) not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach (Anaes.)

8  Schedule 1 (cell at item 18234, column 2)

Repeal the cell, substitute:

 

Trigeminal nerve, primary branch (ophthalmic, maxillary or mandibular branches, excluding infraorbital nerve), injection of an anaesthetic agent or steroid, but not in association with a service to which an item in Group T8 applies, unless a targeted percutaneous technique is used (Anaes.)

9  Schedule 1 (cell at item 18236, column 2)

Repeal the cell, substitute:

 

Trigeminal nerve, peripheral branch (including infraorbital nerve), injection of an anaesthetic agent, but not in association with a service to which an item in Group T8 applies, unless a targeted percutaneous technique is used (Anaes.)

10  Schedule 1 (item 18238, column 2)

After “applies”, insert “, not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach”.

11  Schedule 1 (items 18244, 18252, 18254, 18262 and 18264, column 2)

After “agent”, insert “, not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach”.

12  Schedule 1 (item 18266, column 2)

After “block”, insert “, not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach”.

13  Schedule 1 (item 18274)

Repeal the item.

14  Schedule 1 (items 18278 and 18280, column 2)

After “agent”, insert “, not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach”.

15  Schedule 1 (cell at item 18284, column 2)

Repeal the cell, substitute:

 

Cervical or thoracic sympathetic chain, injection of an anaesthetic agent (Anaes.)

16  Schedule 1 (cell at item 18286, column 2)

Repeal the cell, substitute:

 

Lumbar or pelvic sympathetic chain, injection of an anaesthetic agent (Anaes.)

17  Schedule 1 (item 18288, column 2)

After “agent”, insert “, not in association with a service to which an item in Group T8 applies, unless the nerve block is performed using a targeted percutaneous approach”.

18  Schedule 1 (items 18290, 18292 and 18294, column 2)

After “agent”, insert “under image guidance”.

19  Schedule 1 (cell at item 18296, column 2)

Repeal the cell, substitute:

 

Lumbar or pelvic sympathetic chain, destruction by a neurolytic agent under image guidance (Anaes.)

20  At the end of clause 5.9.5 of Schedule 1

Add:

             (3)  Items 23010 to 24136 apply to a service provided to a patient under anaesthesia, but only if the anaesthesia start and end times are recorded in writing.

21  Schedule 1 (item 20402, column 2)

After “breast”, insert “, including implant reconstruction and exchange”.

22  Schedule 1 (item 20403, column 2)

Omit “removal of breast lump or for breast segmentectomy, if axillary node dissection is performed”, substitute “axillary dissection or sentinel node biopsy”.

23  Schedule 1 (cell at item 20745, column 2)

Repeal the cell, substitute:

 

Initiation of the management of anaesthesia for any of the following:

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

(b) endoscopic retrograde cholangiopancreatography;

(c) upper gastrointestinal endoscopic ultrasound;

(d) percutaneous endoscopic gastrostomy;

(e) upper gastrointestinal endoscopic mucosal resection of tumour

24  Schedule 1 (item 21214, column 2)

Omit “total hip replacement or revision”, substitute “primary total hip replacement”.

25  Schedule 1 (after item 21214)

Insert:

 

21215

Initiation of management of anaesthesia for revision total hip replacement

309.00

26  Schedule 1 (cell at item 38276, column 2)

Repeal the cell, substitute:

 

Transcatheter occlusion of left atrial appendage, and cardiac catheterisation performed by the same practitioner, for stroke prevention in a patient who has non‑valvular atrial fibrillation, if:

(a) the patient is at increased risk of thromboembolism demonstrated by:

(i) a prior stroke (whether of an ischaemic or unknown type), transient ischaemic attack or non‑central nervous system systemic embolism; or

(ii) at least 2 of the following risk factors:

(A) an age of 65 years or more;

(B) hypertension;

(C) diabetes mellitus;

(D) heart failure or left ventricular ejection fraction of 35% or less (or both);

(E) vascular disease (prior myocardial infarction, peripheral artery disease or aortic plaque); and

(b) the patient has an absolute and permanent contraindication to oral anticoagulation (confirmed by written documentation that is provided by a medical practitioner, independent of the practitioner rendering the service); and

(c) the service is not associated with a service to which item 38200, 38203, 38206 or 38254 applies (H) (Anaes.) (Assist.)

27  Schedule 1 (cell at item 39013, column 2)

Repeal the cell, substitute:

 

Injection of one or more zygo‑apophyseal or costo‑transverse joints with one or more of contrast media, local anaesthetic or corticosteroid under image guidance (Anaes.)

28  Schedule 1 (after item 39013)

Insert:

 

39014

Medial branch block of one or more primary posterior rami, injection of an anaesthetic agent under image guidance (Anaes.)

129.90

29  Schedule 1 (cell at item 39100, column 2)

Repeal the cell, substitute:

 

Injection of primary branch of trigeminal nerve (ophthalmic, maxillary or mandibular branches) with alcohol, cortisone, phenol, or similar neurolytic substance, under image guidance (Anaes.)

30  Schedule 1 (after item 39109)

Insert:

 

 

39110

Left lumbar percutaneous zygapophyseal joint denervation by radio‑frequency probe, or cryoprobe, using radiological imaging control, applicable not more than 3 times in a 12 month period (Anaes.)

278.90

39111

Right lumbar percutaneous zygapophyseal joint denervation by radio‑frequency probe, or cryoprobe, using radiological imaging control, applicable not more than 3 times in a 12 month period (Anaes.)

278.90

31  Schedule 1 (item 39115)

Repeal the item, substitute:

 

39116

Left thoracic percutaneous zygapophyseal joint denervation by radio‑frequency probe, or cryoprobe, using radiological imaging control, applicable not more than 3 times in a 12 month period (Anaes.)

309.90

39117

Right thoracic percutaneous zygapophyseal joint denervation by radio‑frequency probe or cryoprobe using radiological imaging control, applicable not more than 3 times in a 12 month period (Anaes.)

309.90

32  Schedule 1 (item 39118)

Repeal the item, substitute:

 

39118

Left cervical percutaneous zygapophyseal joint denervation by radio‑frequency probe, or cryoprobe, using radiological imaging control, applicable not more than 3 times in a 12 month period (Anaes.)

340.90

39119

Right cervical percutaneous zygapophyseal joint denervation by radio‑frequency probe, or cryoprobe, using radiological imaging control, applicable not more than 3 times in a 12 month period (Anaes.)

340.90

33  Schedule 1 (cell at item 39125,column 2)

Repeal the cell, substitute:

Spinal catheter, insertion or replacement of, and connection to a subcutaneous implanted infusion pump, for the management of chronic pain, including cancer pain (H) (Anaes.) (Assist.)

34  Schedule 1 (cell at item 39126,column 2)

Repeal the cell, substitute:

 

All of the following:

(a) infusion pump, subcutaneous implantation or replacement of;

(b) connection of the pump to a spinal catheter;

(c) filling of reservoir with a therapeutic agent or agents;

with or without programming the pump, for the management of chronic pain, including cancer pain (H) (Anaes.) (Assist.)

35  Schedule 1 (cell at item 39127,column 2)

Repeal the cell, substitute:

 

Subcutaneous reservoir and spinal catheter, insertion of, for the management of chronic pain, including cancer pain (H) (Anaes.)

36  Schedule 1 (cell at item 39128, column 2)

Repeal the cell, substitute:

 

All of the following:

(a) infusion pump, subcutaneous implantation of;

(b) spinal catheter, insertion of;

(c) connection of pump to catheter;

(d) filling of reservoir with a therapeutic agent or agents;

with or without programming the pump, for the management of chronic pain, including cancer pain (H) (Anaes.) (Assist.)

37  Schedule 1 (after item 39128)

Insert:

 

39129

Peripheral lead or leads, percutaneous placement of, including intraoperative test stimulation, for the management of chronic neuropathic pain (H) (Anaes.) (Assist.)

631.30

38  Schedule 1 (cell at item 39130,column 2)

Repeal the cell, substitute:

 

Epidural lead or leads, percutaneous placement of, including intraoperative test stimulation, for the management of chronic neuropathic pain or pain from refractory angina pectoris (H) (Anaes.) (Assist.)

39  Schedule 1 (cell at item 39131,column 2)

Repeal the cell, substitute:

 

Epidural or peripheral nerve electrodes (management, adjustment or reprogramming, of neurostimulator), with a medical practitioner attending, for the management of chronic neuropathic pain or pain from refractory angina pectoris—each day

40  Schedule 1 (cell at item 39133,column 2)

Repeal the cell, substitute:

 

Either:

(a) subcutaneously implanted infusion pump, removal of; or

(b) spinal catheter, removal or repositioning of;

for the management of chronic pain, including cancer pain (H) (Anaes.)

41  Schedule 1 (item 39134,column 2)

Omit “intractable”.

42  Schedule 1 (cell at item 39135,column 2)

Repeal the cell, substitute:

 

Neurostimulator or receiver that was inserted for the management of chronic neuropathic pain or pain from refractory angina pectoris, open surgical removal of, performed in the operating theatre of a hospital (H) (Anaes.) (Assist.)

43  Schedule 1 (cell at item 39136,column 2)

Repeal the cell, substitute:

 

Epidural or peripheral nerve lead that was implanted for the management of chronic neuropathic pain or pain from refractory angina pectoris, open surgical removal of, performed in the operating theatre of a hospital (H) (Anaes.) (Assist.)

44  Schedule 1 (cell at item 39137,column 2)

Repeal the cell, substitute:

Epidural or peripheral nerve lead that was implanted for the management of chronic neuropathic pain or pain from refractory angina pectoris, open surgical repositioning of, to correct displacement or unsatisfactory positioning, including intraoperative test stimulation, other than a service to which item 39130, 39138 or 39139 applies (H) (Anaes.) (Assist.)

45  Schedule 1 (cell at item 39138,column 2)

Repeal the cell, substitute:

 

Peripheral nerve lead or leads, surgical placement of, including intraoperative test stimulation, for the management of chronic neuropathic pain where the leads are intended to remain in situ long term (H) (Anaes.) (Assist.)

46  Schedule 1 (cell at item 39139,column 2)

Repeal the cell, substitute:

 

Epidural lead, surgical placement of one or more of by partial or total laminectomy, including intraoperative test stimulation, for the management of chronic neuropathic pain or pain from refractory angina pectoris (H) (Anaes.) (Assist.)

47  Schedule 1 (cell at item 39323,column 2)

Repeal the cell, substitute:

 

Percutaneous denervation (excluding medial branch nerve) by cryotherapy or radiofrequency probe, other than a service to which another item applies, applicable not more than 6 times for a given nerve in a 12 month period (Anaes.)

Part 2Gynaecological services

Health Insurance (General Medical Services Table) Regulations 2021

48  Schedule 1 (cell at item 11900, column 2)

Repeal the cell, substitute:

 

Urine flow study, including peak urine flow measurement, not being a service associated with a service to which item 11912, 11917 or 11919 applies

49  Schedule 1 (item 11912)

Repeal the item, substitute:

 

11912

Cystometrography:

(a) with measurement of any one or more of the following:

(i) urine flow rate;

(ii) urethral pressure profile;

(iii) urethral sphincter electromyography; and

(b) with simultaneous measurement of:

(i) rectal pressure; or

(ii) stomal or vaginal pressure if rectal pressure is not possible;

not being a service associated with a service to which any of items 11012 to 11027, 11900, 11917, 11919 and 36800 or an item in Group I3 of the diagnostic imaging services table applies (Anaes.)

205.50

50  Schedule 1 (cell at item 11917, column 2)

Repeal the cell, substitute:

 

Cystometrography, in conjunction with real time ultrasound of one or more components of the urinary tract:

(a) with measurement of any one or more of the following:

(i) urine flow rate;

(ii) urethral pressure profile;

(iii) urethral sphincter electromyography; and

(b) with simultaneous measurement of:

(i) rectal pressure; or

(ii) stomal or vaginal pressure if rectal pressure is not possible;

including all imaging associated with cystometrography, not being a service associated with a service to which any of items 11012 to 11027, 11900, 11912, 11919 and 36800 or an item in Group I3 of the diagnostic imaging services table applies (Anaes.)

51  Schedule 1 (cell at item 13203, column 2)

Repeal the cell, substitute:

 

Ovulation monitoring services for artificial insemination or gonadotrophin, stimulated ovulation induction, including quantitative estimation of hormones and ultrasound examinations, being services rendered during one treatment cycle but excluding a service to which item 13200, 13201, 13202, 13212, 13215 or 13218 applies

52  Schedule 1 (after item 13221)

Insert:

 

13241

Open surgical testicular sperm retrieval, unilateral, using operating microscope, including the exploration of scrotal contents, with biopsy, for the purposes of intracytoplasmic sperm injection, for male factor infertility, not being a service associated with a service to which item 13218 or 37604 applies (H) (Anaes.)

884.45

53  Schedule 1 (item 35503)

Repeal the item, substitute:

 

35503

Introduction of an intra‑uterine device for abnormal uterine bleeding or contraception or for endometrial protection during oestrogen replacement therapy, if the service is not associated with a service to which another item in this Group applies (other than a service described in item 30062, 35506 or 35620) (Anaes.)

83.40

54  Schedule 1 (cell at item 35506, column 2)

Repeal the cell, substitute:

 

Intra‑uterine device, removal of under general anaesthesia, for a retained or embedded device, not being a service associated with a service to which another item in this Group applies (other than a service described in item 35503) (Anaes.)

55  Schedule 1 (item 35513, column 2)

Omit “cyst”, substitute “abscess, cyst or gland”.

56  Schedule 1 (item 35517, column 2)

Omit “cyst”, substitute “abscess, cyst”.

57  Schedule 1 (item 35518, column 2)

After “reproductive techniques”, insert “, and not in cases of suspected or possible malignancy”.

58  Schedule 1 (cell at item 35527, column 2)

Repeal the cell, substitute:

 

Urethral caruncle, symptomatic excision of, if:

(a) conservative management has failed; or

(b) there is a suspicion of malignancy

(Anaes.)

59  Schedule 1 (cell at item 35536, column 2)

Repeal the cell, substitute:

 

Vulva, wide local excision or hemivulvectomy, one or both procedures, for suspected malignancy or vulval lesions with a high risk of malignancy (Anaes.) (Assist.)

60  Schedule 1 (cell at item 35539, column 2)

Repeal the cell, substitute:

 

Colposcopically directed laser therapy for histologically confirmed high grade intraepithelial neoplastic changes of the vagina, vulva, urethra or anal canal, including any associated biopsies—one anatomical site (Anaes.)

61  Schedule 1 (item 35545, column 2)

Omit “CO2”.

62  Schedule 1 (item 35548, column 3)

Omit “867.85”, substitute “1,301.75”.

63  Schedule 1 (item 35552, column 2)

After “unilateral,”, insert “or sentinel node dissection”.

64  Schedule 1 (cell at item 35557, column 2)

Repeal the cell, substitute:

 

Vagina, complete excision of benign tumour (including Gartner duct cyst), with histological documentation (Anaes.)

65  Schedule 1 (cell at item 35560, column 2)

Repeal the cell, substitute:

 

Partial or complete vaginectomy, for either or both of the following:

(a) deeply infiltrating vaginal endometriosis, if accompanied by histological confirmation from excised tissue;

(b) pre‑invasive or invasive lesions

Not being a service associated with hysterectomy for non‑invasive indications (H) (Anaes.) (Assist.)

66  Schedule 1 (item 35561, column 3)

Omit “1,435.35”, substitute “1,597.25”.

67  Schedule 1 (item 35562, column 3)

Omit “1,178.45”, substitute “1,345.55”.

68  Schedule 1 (item 35564, column 3)

Omit “544.00”, substitute “672.80”.

69  Schedule 1 (cell at item 35568, column 2)

Repeal the cell, substitute:

 

Procedures for the management of symptomatic upper vaginal (vault or cervical) prolapse by sacrospinous or ilococcygeus fixation (H) (Anaes.) (Assist.)

70  Schedule 1 (cell at item 35578, column 2)

Repeal the cell, substitute:

 

Colpocleisis for pelvic organ prolapse, not being a service associated with a service to which another item (other than item 35599) in this Subgroup applies (H) (Anaes.) (Assist.)

71  Schedule 1 (after item 35585)

Insert:

 

35591

Rectovaginal fistula repair of, by vaginal route approach, not being a service associated with a service to which item 35592, 35596, 37029, 37333 or 37336 applies (H) (Anaes.) (Assist.)

962.20

35592

Vesicovaginal fistula closure of, by vaginal approach, not being a service associated with a service to which item 35591, 35596, 37029, 37333 or 37336 applies (H) (Anaes.) (Assist.)

962.20

72  Schedule 1 (items 35595 and 35596

Repeal the items, substitute:

 

35595

Procedure for the management of symptomatic vaginal vault or cervical prolapse, by uterosacral ligament suspension, by any approach, without graft, if the uterosacral ligaments are separately identified, transfixed and then incorporated into rectovaginal and pubocervical fascia of the vaginal vault, including cystoscopy to check ureteric integrity (H) (Anaes.) (Assist.)

649.90

35596

Fistula between genital and urinary or alimentary tracts, repair of, other than a service to which item 35591, 35592, 37029, 37333 or 37336 applies (H) (Anaes.) (Assist.)

962.20

73  Schedule 1 (cell at item 35597, column 2)

Repeal the cell, substitute:

 

Sacral colpopexy, by any approach where graft or mesh is secured to vault, anterior and posterior compartments and to sacrum for correction of symptomatic upper vaginal vault prolapse (H) (Anaes.) (Assist.)

74  Schedule 1 (cell at item 35608, column 2)

Repeal the cell, substitute:

 

Cervix, one or more biopsies, cauterisation (other than by chemical means), ionisation, diathermy or endocervical curettage of, with or without dilatation of cervix (Anaes.)

75  Schedule 1 (after item 35608)

Insert:

 

35609

Cervix, cone biopsy or amputation (Anaes.)

226.80

35610

Cervix, cone biopsy for histologically proven malignancy (Anaes.)

396.95

76  Schedule 1 (cell at item 35611, column 2)

Repeal the cell, substitute:

 

Removal of cervical or vaginal polyp or polypi, with or without dilatation of cervix, not being a service associated with a service to which item 35608 applies (Anaes.)

77  Schedule 1 (item 35612, column 2)

After “approach”, insert “for non‑malignant lesions”.

78  Schedule 1 (cell at item 35614, column 2)

Repeal the cell, substitute:

 

Examination of the lower genital tract using a colposcope in a patient who:

(a) has a human papilloma virus related gynaecology indication; or

(b) has symptoms or signs suspicious of lower genital tract malignancy; or

(c) is undergoing follow‑up treatment of lower genital tract malignancy; or

(d) is undergoing assessment or surveillance of a vulvovaginal pre‑malignant or malignant disease; or

(e) is undergoing assessment or surveillance as part of an identified at risk population

79  Schedule 1 (item 35615)

Repeal the item, substitute:

 

35615

Vulva or vagina, biopsy of, when performed in conjunction with a service to which item 35614 applies

73.25

80  Schedule 1 (cell at item 35616, column 2)

Repeal the cell, substitute:

 

Endometrial ablation by thermal balloon or radiofrequency electrosurgery, for abnormal uterine bleeding, with or without endometrial sampling, including any hysteroscopy performed on the same day (H) (Anaes.)

81  Schedule 1 (cell at item 35620, column 2)

Repeal the cell, substitute:

 

Endometrial biopsy for pathological assessment in women with abnormal uterine bleeding or post‑menopausal bleeding (Anaes.)

82  Schedule 1 (cell at item 35622, column 2)

Repeal the cell, substitute:

 

Endometrial ablation, using hysteroscopically guided electrosurgery or laser energy for abnormal uterine bleeding, with or without endometrial sampling, not being a service associated with a service to which item 30390 applies (H) (Anaes.)

83  Schedule 1 (cell at item 35623, column 2)

Repeal the cell, substitute:

 

Endometrial ablation and resection of myoma or uterine septum (or both), using hysteroscopic guided electrosurgery or laser energy, for abnormal uterine bleeding, with or without endometrial sampling (H) (Anaes.)

84  Schedule 1 (item 35626)

Repeal the item, substitute:

 

35626

Hysteroscopy for investigation of suspected intrauterine pathology, with or without local anaesthesia, including any associated endometrial biopsy, not being a service associated with a service to which item 35630 applies

233.10

85  Schedule 1 (cell at item 35630, column 2)

Repeal the cell, substitute:

 

Hysteroscopy for investigation of suspected intrauterine pathology if performed under general anaesthesia, including any associated endometrial biopsy, not being a service associated with a service to which item 35626 applies (H) (Anaes.)

86  Schedule 1 (after item 35630)

Insert:

 

35631

Operative laparoscopy, including any of the following:

(a) unilateral or bilateral ovarian cystectomy;

(b) salpingo‑oophorectomy;

(c) salpingectomy for tubal pathology (including ectopic pregnancy by tubal removal or salpingostomy, but excluding sterilisation);

(d) excision of stage II (mild) endometriosis;

not being a service associated with a service to which any other intraperitoneal or retroperitoneal procedure item (other than item 30724 or 30725) applies (H) (Anaes.) (Assist.)

740.35

35632

Complicated operative laparoscopy, including either or both of the following:

(a) excision of stage III endometriosis;

(b) laparoscopic myomectomy for a myoma of at least 4cm, including incision and repair of the uterus;

not being a service associated with a service to which any other intraperitoneal or retroperitoneal procedure item (other than item 30724 or 30725 or 35658) applies (H) (Anaes.) (Assist.)

925.40

87  Schedule 1 (cell at item 35633, column 2)

Repeal the cell, substitute:

 

Hysteroscopy, under visual guidance, including any of the following:

(a) removal of an intra‑uterine device;

(b) removal of polyps by any method;

(c) division of minor adhesions (ESH Grade 1)

(Anaes.)

88  Schedule 1 (cell at item 35635, column 2)

Repeal the cell, substitute:

 

Hysteroscopy involving division of:

(a) a uterine septum; or

(b) intrauterine adhesions ESH Grade 2 or higher (H) (Anaes.)

89  Schedule 1 (item 35636, column 2)

Omit “involving resection of myoma, or resection of”, substitute “resection of myoma or”.

90  Schedule 1 (cell at item 35637, column 2)

Repeal the cell, substitute:

 

Operative laparoscopy, including any of the following:

(a) excision or ablation of stage l (minor) endometriosis;

(b) division of pathological adhesions;

(c) sterilisation by application of clips, division, destruction or removal of tubes;

not being a service associated with a service to which any other item in this Group applies (H) (Anaes.) (Assist.)

91  Schedule 1 (cell at item 35640, column 2)

Repeal the cell, substitute:

 

Uterus, curettage of, with or without dilation (including curettage for incomplete miscarriage), if performed under:

(a) general anaesthesia; or

(b) epidural or spinal (intrathecal) nerve block; or

(c) sedation;

including procedures (if performed) to which item 35626 or 35630 applies (Anaes.)

92  Schedule 1 (item 35641, column 2)

Omit “level 4 or 5, laparoscopic resection of, involving any”, substitute “rAFS stage IV, laparoscopic resection of, involving”.

93  Schedule 1 (item 35641, column 2)

Omit “if the operating time exceeds 90 minutes”.

94  Schedule 1 (cell at item 35643, column 2)

Repeal the cell, substitute:

 

Evacuation of the contents of the gravid uterus by curettage or suction curettage, if performed under:

(a) local anaesthesia; or

(b) general anaesthesia; or

(c) epidural or spinal (intrathecal) nerve block; or

(d) sedation;

including procedures (if performed) to which item 35626 or 35630 applies (Anaes.)

95  Schedule 1 (cell at item 35644, column 2)

Repeal the cell, substitute:

 

Cervix, ablation by electrocoagulation diathermy, laser or cryotherapy, with colposcopy, including any local anaesthesia and biopsies, for previously biopsy confirmed HSIL (CIN 2/3) in a patient with a Type 1 or 2 (completely visible) transformation zone, if there is:

(a) no evidence of invasive or glandular disease; and

(b) no discordance between cytology and previous histology;

not being a service associated with a service to which item 35647 or 35648 applies (Anaes.)

96  Schedule 1 (cell at item 35645, column 2)

Repeal the cell, substitute:

 

Cervix, ablation by electrocoagulation diathermy, laser or cryotherapy, with colposcopy, including any local anaesthesia or biopsies, in conjunction with ablative therapy of additional areas of biopsy proven high grade intraepithelial lesions of one or more sites of the vagina, vulva, urethra or anus, for previously biopsy confirmed HSIL (CIN2/3) in a patient with a Type 1 of 2 (completely visible) transformation zone, if there is:

(a) no evidence of invasive or glandular disease; and

(b) no discordance between cytology and previous histology;

not being a service associated with a service to which item 35647 or 35648 applies (Anaes.)

97  Schedule 1 (cell at item 35647, column 2)

Repeal the cell, substitute:

 

Cervix, complete excision of the endocervical transformation zone, using large loop or laser therapy, including any local anaesthesia and biopsies (Anaes.)

98  Schedule 1 (cell at item 35648, column 2)

Repeal the cell, substitute:

 

Cervix, complete excision of the endocervical transformation zone, using large loop or laser therapy, including any local anaesthesia and biopsies, in conjunction with ablative treatment of additional areas of biopsy‑proven high grade intraepithelial lesions of one or more sites of the vagina, vulva, urethra or anus (Anaes.)

99  Schedule 1 (cell at item 35649, column 2)

Repeal the cell, substitute:

 

Myomectomy, one or more myomas, when undertaken by an open abdominal approach (H) (Anaes.) (Assist.)

100  Schedule 1 (cell at item 35653, column 2)

Repeal the cell, substitute:

 

Hysterectomy, abdominal, with or without removal of fallopian tubes and ovaries (H) (Anaes.) (Assist.)

101  Schedule 1 (cell at item 35657, column 2)

Repeal the cell, substitute:

 

Hysterectomy, vaginal, with or without uterine curettage, inclusive of posterior culdoplasty, not being a service to which item 35673 applies (H) (Anaes.) (Assist.)

102  Schedule 1 (cell at item 35658, column 2)

Repeal the cell, substitute:

 

Uterus (at least equivalent in size to a 10 week gravid uterus), debulking of, prior to vaginal or laparoscopic removal at hysterectomy or myoma of at least 4 cm removed by laparoscopy when retrieved from the abdomen (H) (Anaes.) (Assist.)

103  Schedule 1 (item 35661)

Repeal the item, substitute:

 

35661

Hysterectomy, abdominal, that concurrently requires extensive retroperitoneal dissection with exposure of one or both ureters and complex side wall dissection, including when performed with one or more of the following procedures:

(a) salpingectomy;

(b) oophorectomy;

(c) excision of ovarian cyst

(H) (Anaes.) (Assist.)

1,755.35

104  Schedule 1 (item 35667)

Repeal the item, substitute:

 

35667

Radical hysterectomy or radical trachelectomy (with or without excision of uterine adnexae) for proven malignancy, including excision of any one or more of the following:

(a) parametrium;

(b) paracolpos;

(c) upper vagina;

(d) contiguous pelvic peritoneum;

utilising nerve sparing techniques and involving ureterolysis, if performed (H) (Anaes.) (Assist.)

1,658

35668

Hysterectomy, radical (with or without excision of uterine adnexae) including excision of any one or more of the following:

(a) parametrium;

(b) paracolpos;

(c) upper vagina;

(d) contiguous pelvic peritoneum;

utilising nerve sparing techniques and involving ureterolysis, if performed in a patient with malignancy and previous pelvic radiation or chemotherapy treatment (H) (Anaes.) (Assist.)

1,926.35

35669

Hysterectomy, peripartum, performed for histologically proven placenta increta or percreta, or placenta accreta, if the patient has been referred to another practitioner for the management of severe intractable peripartum haemorrhage (H) (Anaes.)(Assist.)

1,926.35

105  Schedule 1 (after item 35670)

Insert:

 

35671

Hysterectomy, peripartum, for ongoing intractable haemorrhage where other haemorrhage control techniques have failed, for the purpose of providing lifesaving emergency treatment, not being a service associated with a service to which item 35667, 35668 or 35669 applies (H) (Anaes.) (Assist.)

1,511.10

 

106  Schedule 1 (cell at item 35673, column 2)

Repeal the cell, substitute:

 

Hysterectomy, vaginal, with or without uterine curettage, with salpingectomy, oophorectomy or excision of ovarian cyst, one or more, one or both sides, inclusive of a posterior culdoplasty, not being a service to which item 35657 applies (H) (Anaes.) (Assist.)

107  Schedule 1 (cell at item 35694, column 2)

Repeal the cell, substitute:

 

Tuboplasty (salpingostomy or salpingolysis), unilateral or bilateral, one or more procedures (H) (Anaes.) (Assist.)

108  Schedule 1 (item 35697, column 2)

After “Microsurgical”, insert “or laparoscopic”.

109  Schedule 1 (item 35700, column 2)

Omit “anastomosis of, using operating microscope”, substitute “or laparoscopic anastomosis of”.

110  Schedule 1 (item 35703, column 2)

Omit “, other than a service associated with a service to which another item in this Subgroup applies”.

111  Schedule 1 (items 35717, 35720 and 35723)

Repeal the items, substitute:

 

35717

Laparotomy, involving oophorectomy, salpingectomy, salpingo‑oophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—one or more such procedures, unilateral or bilateral, including adhesiolysis, for benign disease (including ectopic pregnancy by tubal removal or salpingostomy), not being a service associated with hysterectomy (H) (Anaes.) (Assist.)

887.75

35720

Radical debulking, involving the radical excision of a macroscopically disseminated gynaecological malignancy from the pelvic cavity, including resection of peritoneum from the following:

(a) the pelvic side wall;

(b) the pouch of Douglas;

(c) the bladder;

for macroscopic disease confined to the pelvis, not being a service associated with a service to which item 35721 applies (H) (Anaes.) (Assist.)

1659.55

35721

Radical debulking, involving the radical excision of a macroscopically disseminated gynaecological malignancy from the abdominal and pelvic cavity, where cancer has extended beyond the pelvis, including any of the following:

(a) resection of peritoneum over any of the following:

(i) the diaphragm;

(ii) the paracolic gutters;

(iii) the greater or lesser omentum;

(iv) the porta hepatis;

(b) cytoreduction of recurrent gynaecological malignancy from the abdominal cavity following previous abdominal surgery, radiation or chemotherapy;

(c) cytoreduction of recurrent gynaecological malignancy from the pelvic cavity following previous pelvic surgery, radiation or chemotherapy;

not being a service to which a service associated with a service to which item 35720 or 35726 applies (H) (Anaes.) (Assist.)

3,319.15

35723

Para‑aortic lymph node dissection from above the level of the aortic bifurcation (unilateral), for staging or restaging of gynaecological malignancy (H) (Anaes.) (Assist.)

1,143.25

35724

Para‑aortic lymph node dissection (pelvic or above the aortic bifurcation) after prior similar dissection, radiotherapy or chemotherapy for malignancy (H) (Anaes.) (Assist.)

2,171.30

112  Schedule 1 (cell at item 35726 column 2)

Repeal the cell, substitute:

 

Infra‑colic omentectomy, with or without multiple peritoneal biopsies, for staging or restaging of gynaecological malignancy, not being a service to which item 35721 applies (H) (Anaes.) (Assist.)

113  Schedule 1 (cell at item 35750 column 2)

Repeal the cell, substitute:

 

Hysterectomy, laparoscopic assisted vaginal, by any approach, including any endometrial sampling, with or without removal of the tubes or ovarian cystectomy or removal of the ovaries and tubes due to other pathology, not being a service associated with a service to which item 35595 or 35673 applies. (Anaes.) (Assist.)

114  Schedule 1 (after item 35750)

Insert:

 

35751

Hysterectomy, laparoscopic, by any approach, including any endometrial sampling, with or without removal of the tubes, not being a service associated with a service to which item 35595 applies (H) (Anaes.) (Assist.)

816.40

115  Schedule 1 (cell at item 35753 column 2)

Repeal the cell, substitute:

 

Hysterectomy, complex laparoscopic, by any approach, including endometrial sampling, with either or both of the following procedures:

(a) unilateral or bilateral salpingo‑oophorectomy (excluding salpingectomy);

(b) excision of moderate endometriosis or ovarian cyst;

including any associated laparoscopy, not being a service associated with a service to which item 35595 applies (H) (Anaes.) (Assist.)

116  Schedule 1 (items 35754 and 35756)

Repeal the items, substitute:

 

35754

Hysterectomy, laparoscopic, by any approach, including any of the following procedures:

(a) salpingectomy;

(b) oophorectomy;

(c) excision of ovarian cyst;

(d) any endometrial sampling that concurrently requires complex side wall dissection;

(e) any associated laparoscopy;

other than a service to which item 35595 or 35641 applies (H) (Anaes.) (Assist.)

1,744.35

35756

Hysterectomy, laparoscopic, by any approach, if the procedure is completed by open hysterectomy for control of bleeding or extensive pathology, including any associated laparoscopy, not being a service associated with a service to which item 35595 or 35641 applies (H) (Anaes.) (Assist.)

1,488.90

117  Schedule 1 (item 35759, column 2)

Omit “or abdominal and vaginal approach if”, substitute “, abdominal or laparoscopic approach if”.

118  Schedule 1 (item 37044)

Repeal the item, substitute:

 

37044

Bladder stress incontinence, suprapubic operation for (such as Burch colposuspension), open or laparoscopic route, using native tissue without graft, with diagnostic cystoscopy to assess the integrity of the lower urinary tract, not being a service associated with a service to which item 35599 or 36812 applies (H) (Anaes.) (Assist.)

806.50

Part 3—Miscellaneous amendments

Division 1—Repeals of table items

Health Insurance (General Medical Services Table) Regulations 2021

119  Amendments of listed provisions—repeals

Repeal the following table items in Schedule 1:

                     (a)  item 11903;

                     (b)  item 11906;

                     (c)  item 11909;

                     (d)  item 11915;

                     (e)  item 11921;

                      (f)  item 13206;

                     (g)  item 13292;

                      (h  item 35502;

                      (i)  item 35520;

                      (j)  item 35523;

                     (k)  item 35530;

                      (l)  item 35542;

                    (m)  item 35572;

                     (n)  item 35602;

                     (o)  item 35605;

                     (p)  item 35613;

                     (q)  item 35618;

                      (r)  item 35627;

                      (s)  item 35634;

                      (t)  item 35638;

                     (u)  item 35646;

                     (v)  item 35664;

                    (w)  item 35670;

                     (x)  item 35677;

                     (y)  item 35678;

                     (z)  item 35684;

                    (za)  item 35688;

                   (zb)  item 35706;

                    (zc)  item 35709;

                   (zd)  item 35710;

                    (ze)  item 35713;

                    (zf)  item 37043.

Division 2—Consequential amendments

Health Insurance (General Medical Services Table) Regulations 2021

120  Subclause 1.2.6(1) of Schedule 1

Omit “11921 to 12004”, substitute “12000 to 12004”.

121  Subclause 1.2.7(1) of Schedule 1

Omit “11921”.

122  Subclause 1.2.11(1) of Schedule 1

Omit “11903, 11906, 11909, 11912, 11915, 11919, 12012, 12017, 12021, 12022, 12024, 12200, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250 to 12272, 12500 to 12527, 13015, 13020, 13025, 13200 to 13203, 13206”, substitute “11912, 11919, 12012, 12017, 12021, 12022, 12024, 12200, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250 to 12272, 12500 to 12527, 13015, 13020, 13025, 13200 to 13203”.

123  Schedule 1 (item 11919, column 2)

Omit “, 11921”.

124  Clause 5.2.2 of Schedule 1

Omit “, 13201 and 13206”, substitute “and 13201”.

125  Schedule 1 (items 13200, 13201 and 13202, column 2)

Omit “, 13206”.

126  Schedule 1 (item 13212)

Omit “, 13201 or 13206”, substitute “or 13201”.

127  Schedule 1 (items 13215 and 13218)

Omit “, 13206”.

Part 4Medicare benefits

Health Insurance Regulations 2018

128  Subsection 28(1) (after table item 28B)

Insert:

 

28C

Subgroup 1 of Group A40

91790, 91800, 91801, 91802, 91792, 91803, 91804, 91805, 91794, 91806, 91807, 91808

28D

Subgroup 2 of Group A40

91890, 91891, 91892, 91893, 91894, 91895

28E

Subgroup 3 of Group A40

91818, 91819, 91820, 91821

28F

Subgroup 10 of Group A40

91842, 91843, 91844, 91845

28G

Subgroup 11 of Group A40

92004, 92011

28H

Subgroup 13 of Group A40

92024, 92025, 92026, 92027, 92028, 92055, 92056, 92057, 92058, 92059

28I

Subgroup 15 of Group A40

92136, 92137

28J

Subgroup 16 of Group A40

92138, 92139

28K

Subgroup 17 of Group A40

92142

28L

Subgroup 19 of Group A40

92112, 92113, 92114, 92115, 92116, 92117, 92118, 92119, 92120, 92121, 92122, 92123

28M

Subgroup 20 of Group A40

92126, 92127, 92132, 92133

28N

Subgroup 21 of Group A40

92146, 92147, 92148, 92149, 92150, 92151, 92152, 92153

28O

Subgroup 25 of Group A40

92170, 92171

28P

Subgroup 26 of Group A40

92176, 92177

28Q

Subgroup 27 of Group A40

92182, 92184, 92186, 92188

28R

Subgroup 28 of Group A40

92194, 92196, 92198, 92200

28S

Subgroup 29 of Group A40

92210, 92211

28T

Subgroup 39 of Group A40

92715, 92716, 92717, 92718, 92719, 92720, 92721, 92722, 92723, 92724, 92725, 92726

28U

Subgroup 40 of Group A40

92731, 92732, 92733, 92734, 92735, 92736, 92737, 92738, 92739, 92740, 92741, 92742

28V

Subgroup 41 of Group A40

92746, 92747

28W

Subgroup 1 of Group A41

93287, 93288, 93300, 93301, 93302, 93303, 93304, 93305

28X

Subgroup 2 of Group A41

93291, 93292, 93306, 93307, 93308, 93309, 93310, 93311

28Y

Subgroup 1 of Group A42

93400, 93401, 93402, 93403, 93404, 93405, 93406, 93407

28Z

Subgroup 2 of Group A42

93421, 93422, 93424

28ZA

Subgroup 3 of Group A42

93431, 93432, 93433, 93434, 93435, 93436, 93437, 93438

28ZB

Subgroup 4 of Group A42

93451, 93452, 93453

28ZC

Subgroup 1 of Group A43

93469, 93470

28ZD

Subgroup 2 of Group A43

93475, 93479

28ZE

Subgroup 1 of Group A45

93680, 93681, 93682, 93683, 93684, 93685

28ZF

Subgroup 2 of Group A45

93690, 93691, 93692, 93693, 93694, 93695

28ZG

Subgroup 3 of Group A45

93700, 93701, 93702, 93703, 93704, 93705