Part 1 Preliminary
1. Name
This instrument is the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020.
3. Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
5 Definitions
(1) In this instrument:
Act means the Health Insurance Act 1973.
non-medicare service means a service provided by a nurse practitioner other than a service that is generally accepted in the nursing profession as being necessary for the appropriate treatment of the patient to whom it is rendered.
relevant provisions means all provisions, relating to professional services or medical services, of:
(a) the Act and regulations made under the Act; and
(b) the National Health Act 1953 and regulations made under that Act.
Note The following terms are defined in subsection 3(1) of the Act:
· general medical services table
· participating midwife
· participating nurse practitioner
· pathology services table
(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or 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. Additional definitions for telehealth items
(1) In an item in Part 2 of Schedule 1 or Part 3 of Schedule 2:
care recipient means a person approved as a care recipient under Part 2.3 of the Aged Care Act 1997.
telehealth eligible area means an area classified as a telehealth eligible area by the Minister.
Note A diagram showing telehealth eligible areas can be viewed by searching ‘telehealth eligible areas’ at www.mbsonline.gov.au.
participating in a video consultation means participating in a consultation via video conference with a specialist or consultant physician practising in their specialty where:
(a) there is an item that relates to the specialist or consultant physician’s service; and
(b) the specialist or consultant physician’s service is rendered in Australia.
residential care service has the same meaning as in the Aged Care Act 1997.
Note The following terms are defined in subsection 3(1) of the Act:
· consultant physician
· specialist
6A. Indexation
(1) At the start of 1 July 2023 (the indexation day), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:
Note: The indexed fees could in 2023 be viewed on the Department of Health and Aged Care’s MBS Online website (http://www.health.gov.au).
(2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination, other than the fee for the following:
(a) an item in Group P9.
(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).
Part 2 Midwifery services
7. Interpretation
(1) In this Part:
collaborative arrangement, for a participating midwife’s patient, means a collaborative arrangement mentioned in section 5 of the Health Insurance Regulations 2018.
birth includes episiotomy and repair of tears.
(2) For this Part, a participating midwife is a member of a practice that provides a patient’s antenatal care if the midwife:
(a) participates (whether as a partner, employee or otherwise) in the provision of professional services as part of the practice; or
(b) provides relief services to the practice; or
(c) provides professional services as part of the practice as a locum.
8. Treatment of midwifery services
For subsection 3C(1) of the Act, a midwifery service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Schedule 1 for the service.
9. Collaborative arrangements
For a patient, an item in Schedule 1 applies only if the service mentioned in that item is provided to the patient in accordance with a collaborative arrangement applying to that patient.
10. General requirements
(1) An item in Schedule 1 applies to a service only if:
(a) the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating midwife; and
(b) the midwife:
(i) is not employed by the proprietor of a hospital that is not a private hospital; or
(ii) both:
(A) is employed by the proprietor of a hospital that is not a private hospital; and
(B) provides the service otherwise than in the course of employment by that proprietor.
(2) Subsection (1) applies whether or not another person provides essential assistance to the participating midwife in accordance with accepted clinical practice.
(3) An item in Schedule 1 does not apply to a service provided for a patient if the patient is not in attendance.
Examples — patient not in attendance
1 Completing patient records.
2 Issuing repeat prescriptions.
3 Telephone attendances.
(4) In items 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1:
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.
(5) 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 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
12. Labour and birth
(1) Items 82116, 82118, 82120, 82123, 82125 and 82127 in Part 1 of Schedule 1 apply only to a service provided by a participating midwife during a period of exclusive care of a patient in labour.
(2) Items 82116, 82118, 82120, 82123, 82125 and 82127 in Part 1 of Schedule 1 do not apply if, before labour, the patient’s care is transferred to an obstetrician or medical practitioner who provides obstetric services, for the obstetrician or practitioner to manage the labour and birth.
(3) Items 82118 and 82120 in Part 1 of Schedule 1 applies to a service provided by a participating midwife (the first midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the first midwife to another participating midwife in order to manage fatigue experienced by the first midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
(4) Items 82123 and 82125 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the second midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the second midwife to another participating midwife in order to manage fatigue experienced by the second midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
(5) Item 82127 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the third midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the third midwife to another participating midwife to manage fatigue experienced by the third midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
Part 3 Nurse practitioner services
13. Treatment of nurse practitioner services ‑ general
Subject to section 14, for subsection 3C(1) of the Act, a nurse practitioner service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Schedule 2 relating to the service.
14. Treatment of nurse practitioner services ‑ pathology
For subsection 3C(1) of the Act, a nurse practitioner service described in Part 1 of Schedule 2 provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the pathology services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Part 1 of Schedule 2 relating to the service.
Note 1 A participating nurse practitioner performing a service described in items 73828 to 73837 must be the patient’s treating practitioner in order for medicare benefit to be payable — see subsection 16A(7A) of the Act.
15. Collaborative arrangements and scope of practice
(1) For a patient, an item in Schedule 2 applies only if the service mentioned in that item is:
(a) provided to the patient in accordance with a collaborative arrangement applying to that patient; and
(b) within the scope of practice of the participating nurse practitioner who provides the service.
(2) In this section:
collaborative arrangement, for a participating nurse practitioner’s patient, means a collaborative arrangement mentioned in section 7 of the Health Insurance Regulations 2018.
16. General requirements
(1) An item in Schedule 2, except an item in Part 1 of Schedule 2, applies to a service only if:
(a) the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating nurse practitioner; and
(b) the nurse practitioner:
(i) is not employed by the proprietor of a hospital that is not a private hospital; or
(ii) both:
(A) is employed by the proprietor of a hospital that is not a private hospital; and
(B) provides the service otherwise than in the course of employment by that proprietor.
(2) Subsection (1) applies whether or not another person provides essential assistance to the participating nurse practitioner in accordance with accepted clinical practice.
(3) An item in Schedule 2, except an item in Part 1 of Schedule 2, does not apply to a service provided for a patient if the patient is not in attendance.
Examples — patient not in attendance
1 Completing patient records.
2 Issuing repeat prescriptions.
3 Telephone attendances.
(4) In Part 2 of Schedule 2:
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.
(5) 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 Part 2 of Schedule 2; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
(6) Items 82200, 82205, 82210 and 82215 do not apply to a service described in the item if the service is provided at the same time as, or in connection with, a non-medicare service.
17. Requirements for pathology items
An item in Part 1 of Schedule 2 applies to a service only if the participating nurse practitioner who renders the service:
(a) is not employed by the proprietor of a hospital that is not a private hospital; or
(b) both:
(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.
19. Application of items 73826 to 73837
Section 7 of the Health Insurance (Prescribed Pathology Services) Determination 2021 shall have effect as if the services specified in items 73826 to 73837 of Schedule 2 Part 1 were also specified in that section.
20. Limitation of item 73826
Item 73826 does not apply to a service provided to a patient who has already been provided, in the last 12 months, 4 other services to which any of the following apply:
(a) item 73826;
(b) item 66551;
(c) item 73812.
Part 4 Transitional provisions
21. Transitional provision for item 82115
(1) Between 1 March 2022 and 31 August 2022, item 82115 will apply to a service provided to a patient where the participating midwife has not had at least 2 antenatal attendances with the patient in the 6 months prior to the service provided to the patient.
Schedule 1 Midwifery services and fees
Part 1 Midwifery services and fees
| Group M13 – Midwifery services |
| Subgroup 1 – MBS items for participating midwives |
| Item | Service | Fee ($) |
| 82100 | Initial antenatal professional attendance by a participating midwife, lasting at least 40 minutes, including all of the following: (a) taking a detailed patient history; (b) performing a comprehensive examination; (c) performing a risk assessment; (d) based on the risk assessment — arranging referral or transfer of the patient’s care to an obstetrician; (e) requesting pathology and diagnostic imaging services, when necessary; (f) discussing with the patient the collaborative arrangements for her maternity care and recording the arrangements in the midwife’s written records in accordance with section 6 of the Health Insurance Regulations 2018 Payable only once for any pregnancy | 55.55 |
| 82105 | Short antenatal professional attendance by a participating midwife, lasting up to 40 minutes | 33.60 |
| 82110 | Long antenatal professional attendance by a participating midwife, lasting at least 40 minutes | 55.55 |
| 82115 | Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment and preparation of a maternity care plan for a patient whose pregnancy has progressed beyond 28 weeks, where the participating midwife has had at least 2 antenatal attendances with the patient in the preceding 6 months, if: (a) the patient is not an admitted patient of a hospital; and (b) the participating midwife undertakes a comprehensive assessment of the patient; and (c) the participating midwife develops a written maternity care plan that contains: (i) outcomes of the assessment; and (ii) details of agreed expectations for care during pregnancy, labour and birth; and (iii) details of any health problems or care needs; and (iv) details of collaborative arrangements that apply to the patient; and (v) details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and (vi) details of any referrals or requests for pathology services or diagnostic imaging services for the patient during the pregnancy, and any additional referrals or requests that may be required for the patient; and (d) the maternity care plan is explained and agreed with the patient; and (e) the fee does not include any amount for the management of labour and birth; (Includes any antenatal attendance provided on the same occasion) Payable only once for any pregnancy; This item cannot be claimed if items 16590 or 16591 have previously been claimed during a single pregnancy, except in exceptional circumstances | 331.90 |
| 82116 | Management of labour for up to 6 hours, not including birth, at a place other than a hospital if: (a) the attendance is by the participating midwife who: (i) provided the patient's antenatal care or (ii) is a member of a practice that has provided the patient's antenatal care; and (b) the total attendance time is documented in the patient notes; This item does not apply if birth is performed during the attendance; Only claimable once per pregnancy | 783.85 |
| 82118 | Management of labour for up to 6 hours total attendance, including birth where performed or attendance and immediate post‑birth care at an elective caesarean section if: (a) the patient is an admitted patient of a hospital; and (b) the attendance is by the first participating midwife who: (i) assisted or provided the patient's antenatal care; or (ii) is a member of a practice that has provided the patient's antenatal care; and (c) the total attendance time is documented in the patient notes. (Includes all hospital attendances related to the labour by the first participating midwife) Only claimable once per pregnancy; Not being a service associated with a service to which item 82120 applies (H) | 783.85 |
| 82120 | Management of labour between 6 and 12 hours total attendance, including birth where performed, if: (a) the patient is an admitted patient of a hospital; and (b) the attendance is by the first participating midwife who: (i) assisted or provided the patient’s antenatal care; or (ii) is a member of a practice that provided the patient’s antenatal care; and (c) the total attendance time is documented in the patient notes; (Includes all hospital attendances related to the labour by the first participating midwife) Only claimable once per pregnancy; Not being a service associated with a service to which item 82118 applies (H) | 1,567.70 |
| 82123 | Management of labour for up to 6 hours total attendance, including birth where performed if: (a) the patient is an admitted patient of a hospital; and (b) the attendance is by the second participating midwife who either: (i) assisted or provided the patient's antenatal care; or (ii) is a member of a practice that has provided the patient's antenatal care; and (c) the total attendance time is documented in the patient notes; (Includes all hospital attendances related to the labour by the second participating midwife) Only claimable once per pregnancy; Not being a service associated with a service to which item 82125 applies (H) | 783.85 |
| 82125 | Management of labour between 6 and 12 hours total attendance, including birth where performed, if: (a) the patient is an admitted patient of a hospital; and (b) the attendance is by the second participating midwife who either: (i) assisted or provided the patient’s antenatal care; or (ii) is a member of a practice that provided the patient’s antenatal care; and (c) the total attendance time is documented in the patient notes; (Includes all hospital attendances related to the labour by the second participating midwife) Only claimable once per pregnancy; Not being a service associated with a service to which item 82123 or 82127 applies (H) | 1,567.70 |
| 82127 | Management of labour for up to 6 hours total attendance, including birth where performed if: (a) the patient is an admitted patient of a hospital; and (b) the attendance is by a third participating midwife who either: (i) assisted or provided the patient's antenatal care; or (ii) is a member of a practice that has provided the patient's antenatal care; and (c) an attendance to which item 82123 applies has been provided by a second participating midwife who is a member of a practice that has provided the patient's antenatal care; and (d) the total attendance time is documented in the patient notes; (Includes all hospital attendances related to the labour by the third participating midwife) Only claimable once per pregnancy; Not being a service associated with a service to which item 82125 applies (H) | 783.85 |
| 82130 | Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after birth | 55.55 |
| 82135 | Long postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after birth | 81.70 |
| 82140 | Postnatal professional attendance by a participating midwife on a patient, not less than 6 weeks but not more than 7 weeks after birth of a baby, including: (a) a comprehensive examination of the patient and baby to ensure normal postnatal recovery; and (b) referral of the patient to a general practitioner for the ongoing care of the patient and baby Payable only once for any pregnancy | 55.55 |
Schedule 2 Nurse practitioner services and fees
Part 1 Nurse practitioner pathology services and fees
| Group P9 – Simple basic pathology tests |
| Item | Service | Fee ($) |
| 73826 | Quantitation of glycated haemoglobin (HbA1c) performed by a participating nurse practitioner in the management of established diabetes when performed: (a) as a point‑of‑care test; (b) by a nurse practitioner who works in a general practice that is accredited against the point of care testing accreditation module under the National General Practice Accreditation Scheme; and (c) using a method and instrument certified by the National Glycohemoglobin Standardization Program (NGSP), if the instrument has a total coefficient variation less than 3.0% at 48 mmol/mol (6.5%) Applicable not more than 3 times per 12 months per patient | 11.80 |
| 73828 | Semen examination for presence of spermatozoa by a participating nurse practitioner | 6.90 |
| 73829 | Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count by a participating nurse practitioner ‑ 1 test | 4.55 |
| 73830 | 2 tests described in item 73829 by a participating nurse practitioner | 6.35 |
| 73831 | 3 or more tests described in item 73829 by a participating nurse practitioner | 8.15 |
| 73832 | Microscopy of urine, excluding dipstick testing, by a participating nurse practitioner | 4.55 |
| 73833 | Pregnancy test by 1 or more immunochemical methods by a participating nurse practitioner | 10.15 |
| 73834 | Microscopy for wet film other than urine, including any relevant stain by a participating nurse practitioner | 6.90 |
| 73835 | Microscopy of Gram‑stained film, including (if performed) a service described in item 73832 or 73834 by a participating nurse practitioner | 8.65 |
| 73836 | Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method by a participating nurse practitioner | 2.35 |
| 73837 | Microscopy for fungi in skin, hair or nails by a participating nurse practitioner – 1 or more sites | 6.90 |
Part 2 Nurse practitioner services and fees
| Group M14 – Nurse practitioners |
| Subgroup 1 – Nurse practitioners |
| Item | Service | Fee ($) |
| 82200 | Professional attendance by a participating nurse 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 | 10.00 |
| 82205 | Professional attendance by a participating nurse practitioner lasting less than 20 minutes and including any of the following: (a) taking a history; (b) undertaking clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for 1 or more health related issues, with appropriate documentation | 21.80 |
| 82210 | Professional attendance by a participating nurse practitioner lasting at least 20 minutes and including any of the following: (a) taking a detailed history; (b) undertaking clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for 1 or more health related issues, with appropriate documentation | 41.35 |
| 82215 | Professional attendance by a participating nurse practitioner lasting at least 40 minutes and including any of the following: (a) taking an extensive history; (b) undertaking clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for 1 or more health related issues, with appropriate documentation | 60.95 |