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Health Insurance (General Medical Services Table) Regulations 2018
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Department of Health, Disability and Ageing
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F2018L00766
13 June 2018
-
30 June 2018
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1 Name
2 Commencement
3 Authority
4 General medical services table
5 Dictionary
6 Schedule 2
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Schedule 1—General medical services table
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Part 1—Preliminary
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Division 1.1—Definitions
1.1.1 Meaning of eligible non-vocationally recognised medical practitioner
1.1.2 Meaning of general practitioner
1.1.3 Meaning of multidisciplinary case conference
1.1.4 Meaning of multidisciplinary case conference team
1.1.5 Meaning of single course of treatment
1.1.6 Meaning of symbol (H)
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Division 1.2—General application provisions
1.2.1 Application
1.2.2 Attendance by specialist or consultant physician
1.2.3 Limitation of items—certain attendances by specialists and consultant physicians
1.2.4 Professional attendance services
1.2.5 Personal attendance by medical practitioners generally
1.2.6 Personal attendance by medical practitioners
1.2.7 Application of items—services provided with non-medicare services
1.2.8 Application of items—services provided with autologous injections of blood or blood products
1.2.9 Services that may be provided by persons other than medical practitioners
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Part 2—Services and fees
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Division 2.1—Groups A1 to A9
2.1.1 Meaning of amount under clause 2.1.1
Division 2.2—Group A1: General practitioner attendances to which no other item applies
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Division 2.3—Group A2: Other non-referred attendances to which no other item applies
2.3.1 Effect of determination under section 106TA of Act
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Division 2.4—Group A3: Specialist attendances to which no other item applies
2.4.1 Limitation of items 99 and 113
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Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies
2.5.1 Limitation of items 112 and 114
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Division 2.6—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability
2.6.1 Meanings of eligible allied health provider and risk assessment
2.6.2 Meaning of eligible disability
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Division 2.7—Group A28: Geriatric medicine
2.7.1 Limitation of item 149
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Division 2.8—Group A5: Prolonged attendances to which no other item applies
2.8.1 Application of items 160 to 164
Division 2.9—Group A6: Group therapy
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Division 2.10—Group A7: Acupuncture
2.10.1 Meaning of qualified medical acupuncturist
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Division 2.11—Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies
2.11.1 Application of items 291, 293 and 359
2.11.2 Application of items 342, 344 and 346
2.11.3 Restriction of telepsychiatry consultations to regional, rural and remote areas
2.11.4 Limitation of item 288
2.11.5 Meanings of eligible allied health provider and risk assessment
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Division 2.12—Group A12: Consultant occupational physician attendances to which no other item applies
2.12.1 Consultant occupational physician
2.12.2 Limitation of items 384 and 389
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Division 2.13—Group A13: Public health physician attendances to which no other item applies
2.13.1 Public health physicians
Division 2.14—Miscellaneous services
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Division 2.15—Group A21: Emergency physician attendances to which no other item applies
2.15.1 Meaning of recognised emergency department
2.15.2 Meaning of problem focussed history
2.15.3 Attendance for emergency evaluation of critically ill patients
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Division 2.16—Group A11: Urgent attendances after hours
2.16.1 Meaning of patient’s medical condition requires urgent assessment
2.16.2 Meaning of responsible person
2.16.3 Application of Group A11
2.16.4 Meaning of after-hours rural area
2.16.5 References to general practitioner in items do not include certain participants in After Hours Other Medical Practitioners Program
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Division 2.17—Group A14: Health assessments
2.17.1 Application of Group A14
2.17.2 Types of health assessments
2.17.3 Application of item 715 to certain patients only
2.17.4 Type 2 Diabetes Risk Evaluation
2.17.5 45 year old Health Assessment
2.17.6 Older Person’s Health Assessment
2.17.7 Comprehensive Medical Assessment for permanent resident of residential aged care facility
2.17.8 Health assessment for a person with an intellectual disability
2.17.9 Health assessment for a refugee or other humanitarian entrant
2.17.10 Australian Defence Force Post-discharge GP Health Assessment
2.17.11 Aboriginal and Torres Strait Islander child health assessment
2.17.12 Aboriginal and Torres Strait Islander adult health assessment
2.17.13 Aboriginal and Torres Strait Islander Older Person’s Health Assessment
2.17.14 Restrictions on health assessments for Group A14
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Division 2.18—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences
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Subdivision A—General
2.18.1 Service by medical practitioners
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Subdivision B—Subgroup 1 of Group A15
2.18.2 Meaning of associated medical practitioner
2.18.3 Meaning of contribute to a multidisciplinary care plan
2.18.4 Meaning of coordinating the development of team care arrangements
2.18.5 Meaning of coordinating a review of team care arrangements
2.18.6 Meaning of multidisciplinary care plan
2.18.7 Meaning of preparing a GP management plan
2.18.8 Meaning of reviewing a GP management plan
2.18.9 Application of items 721, 723, 729, 731 and 732
2.18.10 Application of items 721, 723 and 732
2.18.11 Application of items in relation to items 721, 723 and 732
2.18.12 Limitation on items 721, 723, 729, 731 and 732
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Subdivision C—Subgroup 2 of Group A15
2.18.13 Meaning of multidisciplinary discharge case conference
2.18.14 Meaning of multidisciplinary case conference in a residential aged care facility
2.18.15 Meaning of organise and coordinate
2.18.16 Meaning of participate
2.18.17 Meaning of coordinating
2.18.18 Meaning of case conference team
2.18.19 Application of item 880
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Division 2.19—Group A17: Domiciliary and residential medication management reviews
2.19.1 Meaning of living in a community setting
2.19.2 Meaning of residential medication management review
2.19.3 Application of items 900 and 903
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Division 2.20—Group A30: Medical practitioner video conferencing consultation
2.20.1 Application of items
2.20.2 Application of items 2125, 2138, 2179 and 2220
2.20.3 Meaning of amount under clause 2.20.3
2.20.4 Limitation of items
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Division 2.21—Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non-referral attendances associated with PIP payments to which no other item applies)
2.21.1 Application of Subgroup 2 of Groups A18 and A19
2.21.2 Application of Subgroup 3 of Groups A18 and A19
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Division 2.22—Group A20: Mental health care
2.22.1 Definitions
2.22.2 Meaning of amount under clause 2.22.2
2.22.3 Meaning of preparation of a GP mental health treatment plan
2.22.4 Meaning of review of a GP mental health treatment plan
2.22.5 Meaning of associated medical practitioner
2.22.6 Application of Subgroup 1 of Group A20
2.22.7 Focussed psychological strategies
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Division 2.23—Group A24: Palliative and pain medicine
2.23.1 Meaning of organise and coordinate
2.23.2 Meaning of participate
2.23.3 Application of Group A24
2.23.4 Limitation on items
2.23.5 Limitation of items
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Division 2.24—Group A31: Addiction medicine
2.24.1 Meaning of organise and coordinate
2.24.2 Meaning of participate
2.24.3 Limitation of items 6025 and 6026
2.24.4 Application of item 6028
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Division 2.25—Group A32: Sexual health medicine
2.25.1 Meaning of organise and coordinate
2.25.2 Meaning of participate
2.25.3 Limitation of items 6059 and 6060
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Division 2.26—Group A27: Pregnancy support counselling
2.26.1 Application of item 4001
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Division 2.27—Group A22: General practitioner after-hours attendances to which no other item applies
2.27.1 Application of Group A22
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Division 2.28—Group A23: Other non-referred after-hours attendances to which no other item applies
2.28.1 Application of Group A23
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Division 2.29—Group A26: Neurosurgery attendances to which no other item applies
2.29.1 Limitation of items 6004 and 6016
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Division 2.30—Group A9: Contact lenses
2.30.1 Application of item 10809
Division 2.31—Miscellaneous services
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Division 2.32—Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
2.32.1 Definitions for item 10997
2.32.2 Application of item 10988
2.32.3 Application of item 10989
2.32.4 Limitation of item 10983
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Division 2.33—Group M1: Management of bulk-billed services
2.33.1 Definitions for Division 2.33
2.33.2 Application of items 10990, 10991 and 10992
Division 2.34—Diagnostic procedures and investigations
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Division 2.35—Group D1: Miscellaneous diagnostic procedures and investigations
2.35.1 Meaning of report
2.35.2 Meaning of qualified sleep medicine practitioner
2.35.3 Application of item 11801
2.35.4 Application of items 12306 to 12322
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Division 2.36—Group D2: Nuclear medicine (non-imaging)
2.36.1 Application of Group D2
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Division 2.37—Group T1: Miscellaneous therapeutic procedures
2.37.1 Meaning of comprehensive hyperbaric medicine facility
2.37.2 Meaning of embryology laboratory services
2.37.3 Meaning of treatment cycle
2.37.4 Items provided as part of treatment cycle relating to assisted reproductive services not to apply
2.37.5 Application of items 13020 to 14245
2.37.6 Limitation on item 13104
2.37.7 Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances
2.37.8 Application of items 14227 to 14242
2.37.9 Application of item 14245
2.37.10 Limitation of item 13210
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Division 2.38—Group T2: Radiation oncology
2.38.1 Meaning of amount under clause 2.38.1
2.38.2 Meaning of approved site
2.38.3 Meaning of IGRT
2.38.4 Meaning of IMRT
2.38.5 Application of Group T2
2.38.6 Application of items 15215 to 15272
2.38.7 Application of items 15556, 15559 and 15562
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Division 2.39—Group T3: Therapeutic nuclear medicine
2.39.1 Application of Group T3
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Division 2.40—Group T4: Obstetrics
2.40.1 Definitions for item 16400
2.40.2 Meaning of midwife in items 16400 and 16408
2.40.3 Application of Group T4
2.40.4 Application of item 16400
2.40.5 Limitation of item 16399
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Division 2.41—Group T6: Examination by anaesthetist
2.41.1 Application of Group T6
2.41.2 Limitation of item 17609
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Division 2.42—Group T7: Regional or field nerve blocks
2.42.1 Meaning of amount under clause 2.42.1
2.42.2 Application of Group T7
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Division 2.43—Group T11: Botulinum toxin
2.43.1 Supply of botulinum toxin
2.43.2 Limitation of certain items
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Division 2.44—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)
2.44.1 Meaning of amount under clause 2.44.1
2.44.2 Meaning of amount under clause 2.44.2
2.44.3 Meaning of complex paediatric case
2.44.4 Meaning of service time
2.44.5 Application of Group T10
2.44.6 Application of Subgroup 21 of Group T10
2.44.7 Services mentioned in Subgroups 21 to 25 of Group T10
2.44.8 Application of Subgroups 22 and 23 of Group T10
2.44.9 Application of Subgroups 24 and 25 of Group T10
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Division 2.45—Group T8: Surgical operations
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Subdivision A—General
2.45.1 Meaning of approved site
2.45.2 Application of Group T8
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Subdivision B—Subgroup 1 of Group T8
2.45.3 Meaning of amount under clause 2.45.3
2.45.4 Meaning of amount under clause 2.45.4
2.45.5 Meaning of qualified surgeon
2.45.6 Meaning of qualified radiologist
2.45.7 Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures
2.45.8 Application of items 30299 and 30300
2.45.9 Application of items 30440, 30451, 30492 and 30495
2.45.10 Application of items 30688, 30690, 30692 and 30694
2.45.11 Application of item 35412
2.45.12 Application of items 31569, 31572, 31575, 31578, 31581, 31587 and 31590
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Subdivision C—Subgroups 2 and 3 of Group T8
2.45.13 Meaning of foreign body in items 35360 to 35363
2.45.14 Application of items 32084, 32087, 32090 and 32093
2.45.15 Application of items 32500 to 32517 and 35321
2.45.16 Application of items 35404, 35406 and 35408
2.45.17 Artificial bowel sphincter
2.45.18 Meaning of eligible stroke centre
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Subdivision D—Subgroups 4, 5 and 6 of Group T8
2.45.19 Application of items 38470 to 38766
Subdivision E—Subgroups 7 to 11 of Group T8
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Subdivision F—Subgroups 12 and 13
2.45.20 Meaning of amount under clause 2.45.20
2.45.21 Meaning of maxilla
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Subdivision G—Subgroup 14
2.45.22 Items 46300 to 46534 apply only in certain circumstances
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Subdivision H—Subgroup 15
2.45.23 Limitation of item 50303
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Division 2.46—Group T9: Assistance at operations
2.46.1 Meaning of amount under clause 2.46.1
2.46.2 Meaning of amount under clause 2.46.2
2.46.3 Meaning of amount under clause 2.46.3
2.46.4 Meaning of previous significant surgical complication
2.46.5 Application of Group T9
2.46.6 Assistance at operations
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Division 2.47—Oral and Maxillofacial services
2.47.1 Application of Groups O1 to O11
Division 2.48—Group O1: Consultations
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Division 2.49—Group O2: Assistance at operation
2.49.1 Meaning of amount under clause 2.49.1
2.49.2 Assistance at operations
Division 2.50—Group O3: General surgery
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Division 2.51—Group O4: Plastic and reconstructive
2.51.1 Meaning of maxilla
Division 2.52—Group O5: Preprosthetic
Division 2.53—Group O6: Neurosurgical
Division 2.54—Group O7: Ear, nose and throat
Division 2.55—Group O8: Temporomandibular joint
Division 2.56—Group O9: Treatment of fractures
Division 2.57—Group O10: Diagnostic procedures and investigations
Division 2.58—Group O11: Regional or field nerve blocks
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Part 3—Dictionary
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3.1 Dictionary
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Schedule 2—Repeals
Health Insurance (General Medical Services Table) Regulations 2017