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Health Insurance Regulations 2018
In force
Administered by
Department of Health and Aged Care
This item is authorised by the following title:
Health Insurance Act 1973
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F2024C01042 (C21)
01 November 2024
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Part 1—Preliminary
1 Name
3 Authority
4 Definitions
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Part 2—Definitional material
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Division 3—Definition of services
9 Professional services—medical services rendered by approved dental practitioners
10 Meaning of specialist trainee
11 Professional services rendered by specialist trainees
12 Health service not specified in an item—meaning of health service
Division 4—Recognition of medical practitioners as specialists and consultant physicians
13 Recognition of medical practitioner domiciled in Australia as specialist—meaning of relevant organisation and relevant qualification
Division 5—General practitioners
16 Medical practitioners who were on Vocational Register of General Practitioners
Division 6—Register of Approved Placements
26 Specified bodies, courses and programs
27 Removal from the Register
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Part 3—Medicare benefits
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Division 1—Amount of medicare benefit
28 Entitlement to medicare benefit—services for which medicare benefit is 100% of Schedule fee
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Division 2—Medicare benefits in relation to pathology services
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Subdivision A—Simplified outline of this Division
29 Simplified outline of this Division
Subdivision B—Specifying services
30 Pathology service determined to be necessary by participating midwife
31 Pathology service determined to be necessary by participating nurse practitioner
Subdivision C—Requirements for requests for pathology services
32 Purpose of Subdivision
33 Information about requesting practitioner
34 Information about patient
35 Information about pathology service
36 Requests that specify an approved pathology practitioner
37 Further requests
Division 3—Medicare benefits in relation to R type diagnostic imaging services
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Subdivision A—Simplified outline of this Division
38 Simplified outline of this Division
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Subdivision B—Specifying services for effective requests
39 Requests by dental practitioners
40 Requests by chiropractors
41 Requests by physiotherapists or osteopaths
42 Requests by podiatrists
43 Requests by participating midwives
44 Requests by participating nurse practitioners
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Subdivision C—Specifying services for pre existing diagnostic imaging practices
45 Exemption from subsection 16B(1) of the Act—pre existing diagnostic imaging practices
Division 4—Medicare benefits in relation to radiation oncology services
46 Meaning of radiation oncology service
Division 5—Particulars of professional services
47 Simplified outline of this Division
48 Purpose of Division
49 All services—particulars of patient, date of service and fees
50 All services—particulars of professional service rendered
51 Most general medical services and Group P9 pathology services—particulars of person rendering service
52 Certain radiation or nuclear services—particulars of person rendering service and person claiming or receiving fees
53 Certain radiation oncology services—use of equipment
54 Pathology services (other than Group P9)—particulars of person rendering service
55 Pathology services—other particulars
56 Diagnostic imaging services—particulars of person rendering service and person claiming or receiving fees
57 Diagnostic imaging services—other particulars
58 Services provided upon referral
59 Multiple professional services in a single day
60 Anaesthesia
Division 6—Professional services rendered by or on behalf of certain medical practitioners
61 Other circumstances in which subparagraphs 19AA(1)(b)(iv) and (2)(b)(iv) of the Act apply
62 Meaning of intern
Division 7—Payments to medical practitioners and approved billing agents
63 Circumstances for electronic payments to medical practitioners
64 Requirements for payments to specialists and consultant physicians
65 Approved billing agents—application requirements and fee
Division 8—Eligible midwives
66 Meaning of eligible midwife—requirements
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Part 4—Special provisions relating to pathology
67 Giving notice of termination of undertaking
68 Approved pathology authorities—other records of pathology services
69 Offences in relation to request forms—branded pathology request forms
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Part 5—Special provisions relating to diagnostic imaging services
70 Requests for diagnostic imaging services—information and form requirements
71 Medical practitioners rendering diagnostic imaging services—other records of services
72 Diagnostic Imaging Register—other information to be included in application for registration
73 Diagnostic Imaging Register—other information to be included on Register
74 Primary information—types of diagnostic imaging equipment
75 Diagnostic imaging accreditation—information to be included on Diagnostic Imaging Register
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Part 6—Prohibited practices in relation to pathology services and diagnostic imaging services
76 Meaning of permitted benefit—method for determining substantial difference from market value
77 Meaning of permitted benefit—method for determining market value
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Part 7—Radiation Oncology Register
78 Radiation Oncology Register—other information to be included in application for registration
79 Radiation Oncology Register—other information to be included on the Register
80 Primary information—types of radiation oncology equipment
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Part 8—Health program grants
81 Application for approval as an organization under Part IV of the Act
82 Application for approval of health service under Part IV of the Act
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Part 9—Medicare Participation Review Committees
83 Meaning of professional organisation
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Part 10—Quality assurance confidentiality
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Division 1—Quality assurance activities—application for declaration
84 Application for declaration that quality assurance activity is activity to which Part VC of the Act applies
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Division 2—Quality assurance activities—public interest criteria
85 Purpose of Division
86 Disclosure of information about quality assurance activities
87 Quality assurance activities engaged in in a single State or Territory
88 Quality assurance activities of a kind that has not previously been engaged in in Australia
89 Quality assurance activities of a kind that has previously been engaged in in Australia
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Part 11—Miscellaneous provisions
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Division 1—Charging of fees for provision of public hospital services to public patients
90 Circumstances in which fees must not be charged for provision of public hospital services to public patients
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Division 2—Recovery of amounts
91 Recovery of debts due to the Commonwealth—prescribed rate of interest
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Division 3—Divulging and using information
92 Divulging information—treatment provided to veterans
93 Divulging information—complaints and investigations
94 Professional disciplinary and regulatory bodies
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Division 4—Manner of patient referrals
95 Purpose and application of Division
96 Who can make referral
97 Requirement to consider need for referral
98 Requirements for form of referral
99 Requirements for contents of referral
100 Requirement to record certain referrals in hospital records
101 Receipt of referral by specialist or consultant physician
102 Period of validity for referrals
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Part 12—Application, saving and transitional provisions
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Division 1—Transitional matters relating to the repeal of the Health Insurance Regulations 1975
103 Things done under the Health Insurance Regulations 1975
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Schedule 1—Specialists
1 Organisations, specialties and qualifications
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Endnotes
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history