Health Insurance (Section 3C General Medical Services – Proton-Photon Comparison Plan) Determination 2025

I, Mary Warner, delegate for the Minister of Health and Aged Care, make the following Determination

Dated 30 April 2025

Mary Warner

Assistant Secretary
Diagnostic Imaging and Pathology Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health and Aged Care

Contents

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

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

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

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

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

6  Indexation................................................2

Schedule 1—Relevant services 3

1  Name

  This instrument is the Health Insurance (Section 3C General Medical Services – Proton-Photon Comparison Plan) 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Note:  This table relates only to the provisions of this instrument as originally made.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

Note: A number of expressions used in this instrument are defined in definitions section of the Act, including the following:

(a) general medical services table;

(b) item;

(c) professional service;

(d) clinically relevant service.

 (1) In this instrument:

Act means the Health Insurance Act 1973.

bulk-billed has the same meaning given by clause 7.1.1 of the general medical services table.

radiation oncologist has the same meaning given by clause 5.3.2 of the general medical services table.

Schedule means a Schedule to this instrument.

 (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.

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 general 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  Indexation

 (1) At the start of 1 July 2025 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

Note:             The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).

 (2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.

 (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).

Schedule 1—Relevant services