Health Insurance (Section 3C General Medical Services – Menopause and Perimenopause and Health Assessment Services) Determination 2025

I, Louise Riley, delegate of the Minister for Health, Disability and Ageing make the following Determination.

Dated  15 May 2025   

Louise Riley
Assistant Secretary
MBS Policy and Reviews Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health, Disability and Ageing

Contents

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

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

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

4  Definitions...............................................1

5  Treatment of relevant services....................................2

6  Application of provisions of the general medical services table.................2

7  Application of items..........................................2

8  Repeal..................................................2

9  Schedules ................................................3

Schedule 1 — Relevant Services 4

1  Name

  This instrument is the Health Insurance (Section 3C General Medical Services – Menopause and Perimenopause Health Assessment Services) Determination 2025.

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.

Note:  This table relates only to the provisions of this instrument as originally made.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.

1.     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 subsection 3C(1) of the Health Insurance Act 1973

4  Definitions

1.       In this instrument:

Act means the Health Insurance Act 1973.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

Note: The following terms are defined in subsection 3(1) of the Act:

• clinically relevant service;
• general medical services table;
• item;
• professional service.

1.       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.

5  Treatment of relevant services

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

1.     it were both a professional service and a medical service; and
2.     there were an item in the general medical services table that:
   1.                     related to the service; and
   2.                     specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

6  Application of provisions of the general medical services table

1.     Clause 2.15.1 of the general medical services table shall have effect as if:
   1.     item 695 is specified in subclause 2.15.1(1) for the purposes of this clause; or
   2.    item 19000 is specified in subclause 2.15.1(2) for the purposes of this clause.
2.     Clause 2.15.14 of the general medical services table shall have effect as if items 695 and 19000 of this Determination were also specified in clause 2.15.14.

7  Application of items

Each of the services listed in Schedule 1 to this instrument applies only to a patient who:

1.     is experiencing one or more symptoms for the following, or undergoing treatment for those symptoms:

1.             premature ovarian insufficiency;
2.             early menopause;
3.             perimenopause;
4.             menopause; and
   1.     has not received either of these services within the preceding 12 months from the date of receiving either of these services.

8  Repeal

  This instrument is repealed at the end of 30 June 2027.

9  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 1 — Relevant Services