Contents

1 Name...................................................2

2 Commencement............................................2

3 Authority................................................2

4 Schedules................................................2

Schedule 1—Amendments 3

Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 3

Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 8

Health Insurance (Section 3C Pathology Services – Point-of-Care Testing Services) Determination 2024 15

1 Name

This instrument is the Health Insurance Legislation Amendment (2025 Measures No. 5) Determination 2025.

2 Commencement

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.

Commencement information
Column 1	Column 2	Column 3
Provisions	Commencement	Date/Details
1. The whole of this instrument	Immediately after the commencement of the Health Insurance Legislation Amendment (2025 Measures No.4) Determination 2025.	1 November 2025

Note: This table relates only to the provisions of this instrument as originally made.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

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 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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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—Amendments

Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024

Section 1

After “Allied Health”, insert “and other Primary Health Care”.

Subsection 4(1)

Insert:

Aboriginal and Torres Strait Islander health and wellbeing service means:

a health service of a kind prescribed by section 12 of the Health Insurance Regulations 2018;

that is specified in an item in Schedule 2, Group M3, Group M11 and Subgroup 2 of Group M10.

Subsection 4(1)

Insert:

Aboriginal and Torres Strait Islander primary health care professional, for the provision of an Aboriginal and Torres Strait Islander health and wellbeing service, means a person:

(a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and

(b) whose name is entered in the register, kept by the Chief Executive Medicare, of Aboriginal and Torres Strait Islander primary health care professionals who are qualified to provide a service of that kind.

Paragraph 4(1)(a) (definition of case conference service)

Repeal the paragraph, substitute:

Aboriginal and Torres Strait Islander health and wellbeing service;

Subsection 4(1) (definition of clinically relevant service)

Repeal the definition, substitute:

clinically relevant service means a service rendered by an allied health professional, nurse practitioner or Aboriginal and Torres Strait Islander primary health care professional that is generally accepted in the relevant health profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.

Subsection 4(1) (definition of eligible Aboriginal and Torres Strait Islander health practitioner)

Repeal the definition, substitute:

eligible Aboriginal and Torres Strait Islander health practitioner means a person who is an Aboriginal and Torres Strait Islander primary health care professional in relation to the provision of one or both of the following:

(a) an Aboriginal and Torres Strait Islander health and wellbeing service because of section 1 of item 1 of Schedule 1 of this instrument;

(b) a mental health service.

Subsection 4(1) (definition of eligible Aboriginal health worker)

Repeal the definition, substitute:

eligible Aboriginal and Torres Strait Islander health worker means a person who is an:

Aboriginal health worker; or
Aboriginal and Torres Strait Islander health worker; or
Torres Strait Islander health worker

who is an Aboriginal and Torres Strait Islander primary health care professional in relation to the provision of one or both of the following:

an Aboriginal and Torres Strait Islander health and wellbeing service because of section 2 of item 1(2) of Schedule 1 of this instrument;
a mental health service.

Subsection 4(1) (definition of eligible mental health worker)

After “allied health professional”, insert “or Aboriginal and Torres Strait Islander primary health care professional”.

Section 6 (heading)

Repeal the heading, substitute:

6 Treatment of allied health and Aboriginal and Torres Strait Islander health and wellbeing services

Section 6

After “allied health service”, insert “or an Aboriginal and Torres Strait Islander primary health and wellbeing service”.

Section 8 (heading)

After “allied health service”, insert “or Aboriginal and Torres Strait Islander health and wellbeing service”.

Subsection 8(1)

After “allied health service”, insert “or Aboriginal and Torres Strait Islander health and wellbeing service”.

Subsection 10(7) (heading)

Omit “Attendance options for the eligible allied health practitioner”, substitute:

Attendance options for the eligible allied health practitioner or eligible Aboriginal and Torres Strait Islander primary health care professional

Subsection 10(7)

After “allied health practitioner”, insert “or eligible Aboriginal and Torres Strait Islander primary health care professional”.

Subsection 11(1) (Note)

Omit “Department of Health and Aged Care’s”, substitute “Department of Health, Disability and Ageing’s”.

Schedule 1 (Title)

Repeal the title, substitute:

Schedule 1 – Qualification requirements for allied health and Aboriginal and Torres Strait Islander primary health care professionals

Clause 1 of Schedule 1

Repeal the clause, substitute:

1 Aboriginal and Torres Strait Islander health and wellbeing service

A person is an Aboriginal and Torres Strait Islander primary health care professional in relation to the provision of an Aboriginal and Torres Strait Islander health and wellbeing service if the person is of Aboriginal, Aboriginal and Torres Strait Islander, or Torres Strait Islander descent, and is:

(a) Registered as an Aboriginal and Torres Strait Islander health practitioner with the Aboriginal and Torres Strait Islander Health Practice Board of Australia; or

(b) An Aboriginal and Torres Strait Islander health worker with a Certificate III or above in Aboriginal and/or Torres Strait Islander Primary Health Care from the Health (HLT) training package.

Clause 9 of Schedule 1

After “allied health professional”, insert “or Aboriginal and Torres Strait Islander primary health care professional”.

Paragraph 9(a) of Schedule 1

Repeal the paragraph, substitute:

(a) the person meets the requirements specified for an Aboriginal and Torres Strait Islander primary health care professional in relation to the provision of an Aboriginal and Torres Strait Islander health and wellbeing service;

Schedule 2 (title)

After “Allied health”, insert “and other primary health care”.

Division 1.1 of Schedule 2 (title)

Omit “allied health chronic disease”, substitute “individual chronic condition”.

Subclause 1.1.2(6) of Schedule 2 (heading)

After “health practitioners”, insert “, nurse practitioners, Aboriginal and Torres Strait Islander primary health care professionals”.

Subclause 1.1.2(6) of Schedule 2

After “health practitioner”, insert “, nurse practitioner, Aboriginal and Torres Strait Islander primary health care professionals”.

Paragraph 1.1.2(6)(a) of Schedule 2

After “Aboriginal”, insert “and Torres Strait Islander”.

Clause 1.1.3 (title) of Schedule 2

After “allied health”, insert “and Aboriginal and Torres Strait Islander health and wellbeing”.

Clause 1.1.3 of Schedule 2 (Group M3 table, heading)

After “Allied health”, insert “and Aboriginal and Torres Strait Islander health and wellbeing”.

Clause 1.1.3 of Schedule 2 (Group M3 table, Subgroup 1, heading)

Omit “Chronic”, insert “Individual chronic”.

Schedule 2 (item 10950, column 2, paragraph)

Omit “Aboriginal and Torres Strait Islander health service provided to a patient by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner if:”, substitute “Aboriginal and Torres Strait Islander health and wellbeing service provided to a patient by an eligible Aboriginal and Torres Strait Islander health worker or eligible Aboriginal and Torres Strait Islander health practitioner if:”.

Clause 1.1.3 of Schedule 2 (Group M3 table, Subgroup 2, heading)

Omit “Chronic”, substitute “Individual chronic”.

Clause 1.1.3 of Schedule 2 (Group M3 table, items 10955, 10957, 10959, column 2, paragraph)

After “allied health practitioner,”, insert “or eligible Aboriginal and Torres Strait Islander primary health care professional,”.

Division 5.1 of Schedule 2 (title)

After “related to”, omit “allied health”.

Paragraph 5.1.5 (4) of Schedule 2 (heading)

After “health practitioners”, insert, “and eligible Aboriginal and Torres Strait Islander primary health care professionals”.

Paragraph 5.1.5(4) of Schedule 2

After “eligible allied health practitioner”, insert “and eligible Aboriginal and Torres Strait Islander primary health care professional”.

Paragraph 5.1.5(4)(a) of Schedule 2

After “Aboriginal”, insert “and Torres Strait Islander”.

Clause 5.1.6 of Schedule 2 (items 82001, 82002 and 82003, column 2, paragraph)

After “allied health practitioner’, insert “or eligible Aboriginal and Torres Strait Islander primary health care professional”.

Part 6 of Schedule 2 (title)

After “Islander”, insert “health and wellbeing”.

Division 6.1 of Schedule 2 (title)

After “Islander”, insert “health and wellbeing”.

Clause 6.1.2 of Schedule 2 (heading)

After “Islander”, insert “health and wellbeing”.

Clause 6.1.2 of Schedule 2 (Group M11 table, heading)

Omit “Allied health”, substitute “Health”.

Clause 6.1.2 of Schedule 2 (Group M11 table, item 81300, column 2)

Omit “service provided to a patient of Aboriginal or Torres Strait Islander descent by an eligible Aboriginal health worker”, substitute:

“and wellbeing service provided to a patient of Aboriginal or Torres Strait Islander descent by an eligible Aboriginal and Torres Strait Islander health worker”.

Clause 6.1.2 of Schedule 2 (Group M11 table, item 81300, column 2, paragraph (a))

Omit “allied health”, substitute “Aboriginal and Torres Strait Islander health and wellbeing”.

Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021

Section 5 (Definitions)

In all instances omit “Allied Health Determination”, substitute “Allied Health and other Primary Health Care Services Determination”.

Section 5 (Definitions)

Insert:

allied health professional, for the provision of an allied health service, means a person:

(a) who meets the qualification requirements set out in Schedule 1 of the Allied Health and other Primary Health Care Services Determination for the provision of the service; and

(b) whose name is entered in the register, kept by the Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind.

Note: Allied health professionals in relation to the provision of a focussed psychological strategies health service are subject to the requirements of section 10 of the Allied Health and other Primary Health Care Services Determination.

Section 5 (definition of Allied Health Determination)

Repeal the definition, substitute:

Allied Health and other Primary Health Care Services Determination means the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.

Section 5 (Definitions)

Insert:

Aboriginal and Torres Strait Islander primary health care professional has the meaning given by section 4 of the Allied Health and other Primary Health Care Services Determination.

Section 5 (definition of Commonwealth Urgent Care Clinic Program)

Omit “Department of Health and Aged Care”, substitute “Department of Health, Disability and Ageing”.

Section 5 (definition of eligible Aboriginal health worker)

After “Aboriginal”, insert “and Torres Strait Islander”.

Section 5 (definition of eligible allied health practitioner)

Repeal the definition, substitute:

eligible allied health practitioner means:

(a) an eligible diabetes educator;

(b) an eligible audiologist;

(d) an eligible mental health worker;

(e) an eligible occupational therapist;

(f) an eligible exercise physiologist;

(g) an eligible physiotherapist;

(h) an eligible podiatrist;

(i) an eligible chiropractor;

(j) an eligible osteopath;

(k) an eligible psychologist; or

(l) an eligible speech pathologist.

Section 5 (definition of eligible allied health practitioner)

After (l) an eligible speech pathologist, Insert:

Note: Eligible allied health practitioner for subgroups 15 and 16 of Group M18 means:

(a) an eligible psychologist;

(b) an eligible speech pathologist;

(d) an eligible audiologist;

(e) an eligible dietitian

(f) an eligible exercise physiologist

(g) an eligible optometrist;

(h) an eligible orthoptist;

(i) an eligible physiotherapist;

Section 5 (Definitions)

Insert:

eligible optometrist has the meaning given by section 4 of the Allied Health and other Primary Health Care Services Determination

Paragraph 7(2)(c)

After “Allied Health”, insert “and other Primary Health Care Services”.

Subsection 7(3) (Note)

After “allied health professionals”, insert “, Aboriginal and Torres Strait Islander primary health care professionals”.

Subsection 8(1) (Note)

Omit “Department of Health and Aged Care’s”, substitute “Department of Health, Disability and Ageing’s”.

Subclause 1.1.03(4) of Schedule 1

Repeal the subclause, substitute:

(4) Practice nurses and Aboriginal and Torres Strait Islander health workers and Aboriginal and Torres Strait Islander health practitioners may assist practitioners in performing a health assessment, in accordance with accepted medical practice, and under the supervision of the practitioner.

Paragraph 1.1.10(2)(b) of Schedule 1

After “Allied Health”, insert “and other Primary Health Care Services”.

Clause 1.1.19 of Schedule 1 (Group A40 table, items 92136, 92137, 92138 and 92139, column 2, paragraph (b))

Omit “of the Allied Health Determination,”.

Schedule 3 (title)

After “Allied Health”, insert “and other Primary Health Care”.

Subclause 3.1.10(1) of Schedule 3

After “Allied Health”, insert “and other Primary Health Care Services”.

Clause 3.1.10 of Schedule 3 (Group M18 table, heading)

After “Allied Health”, insert “and other primary health care”.

Clause 3.1.10 of Schedule 3 (Group M18 table, Subgroup 11 heading)

After “allied health”, insert “and other primary health care”.

Clause 3.1.10 of Schedule 3 (Group M18 table, Subgroup 12 heading)

After “allied health”, insert “and other primary health care”.

Clause 3.1.10 of Schedule 3 (item 93000, column 2)

Repeal the cell, substitute:

Video attendance by an eligible allied health practitioner or Aboriginal and Torres Strait Islander primary health care professional if:

(a) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(b) the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs; and

(d) the service is provided to the person individually; and

(e) the service is of at least 20 minutes duration; and

(f) after the service, the eligible health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

(i) if the service is the only service under the referral—in relation to that service; or

(ii) if the service is the first or last service under the referral—in relation to that service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;

to a maximum of 5 services (including any services to which this item, item 93013 or any item in Subgroup 1 of Group M3 of the Allied Health and other Primary Health Care Services Determination applies) in a calendar year

Clause 3.1.10 of Schedule 3 (item 93013, column 2)

Repeal the cell, substitute:

Phone attendance by an eligible allied health practitioner or Aboriginal and Torres Strait Islander primary health care professional if:

(a) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(b) the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs; and

(d) the service is provided to the person individually; and

(e) the service is of at least 20 minutes duration; and

(f) after the service, the eligible health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

(i) if the service is the only service under the referral—in relation to that service; or

(ii) if the service is the first or last service under the referral—in relation to that service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;

to a maximum of 5 services (including any services to which this item, item 93000 or any item in Subgroup 1 of Group M3 of the Allied Health and other Primary Health Care Services Determination applies) in a calendar year

Clause 3.1.10 of Schedule 3 (items 93026 and 93029, column 2)

Omit “in the Allied Health Determination, item 4001 of the general medical services table and item”, substitute “, 4001,”.

Clause 3.1.10 of Schedule 3 (item 93048, column 2)

Repeal the cell, substitute:

Video attendance provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible allied health practitioner or Aboriginal and Torres Strait Islander primary health care professional if:

(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up health services; or

(b) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs;

(d) the service is provided to the person individually; and

(e) the service is of at least 20 minutes duration; and

(f) after the service, the eligible health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (b):

(i) if the service is the only service under the referral—in relation to that service; or

(ii) if the service is the first or the last service under the referral—in relation to that service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;

to a maximum of 10 services (including any services to which this item or 93000, 93013 or 93061 or any item in Subgroup 1 of Group M3 or any item in Group M11 of the Allied Health and other Primary Health Care Services Determination applies) in a calendar year

Clause 3.1.10 of Schedule 3 (item 93061, column 2)

Repeal the cell, substitute:

Phone attendance provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible allied health or Aboriginal and Torres Strait Islander primary health care professional if:

(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up health services; or

(b) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs;

(d) the service is provided to the person individually; and

(e) the service is of at least 20 minutes duration; and

(f) after the service, the eligible health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (b):

(i) if the service is the only service under the referral—in relation to that service; or

(ii) if the service is the first or the last service under the referral—in relation to that service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;

to a maximum of 10 services (including any services to which this item or item 93000, 93013, 93048 or any item in Subgroup 1 of Group M3 or any item in Group M11 of the Allied Health and other Primary Health Care Services Determination applies) in a calendar year

Clause 3.1.10 of Schedule 3 (item 93284, column 2, paragraph)

Omit “of the Allied Health Determination”.

Clause 3.1.10 of Schedule 3 (item 93285, column 2)

Repeal the cell, substitute:

Video attendance by an eligible dietitian to provide a dietetics health service, as a group service for the management of type 2 diabetes if:

(a) the person has been assessed as suitable for a type 2 diabetes group service under assessment items 81100, 81110, 81120, 93284 or 93286; and

(b) the service is provided to a person who is part of a group of between 2 and 12 patients; and

(d) after the last service in the group services program provided to the person under this item or items 81105, 81115 or 81125, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(e) an attendance record for the group is maintained by the eligible dietitian;

to a maximum of 8 group services in a calendar year (including services to which this item or items 81105, 81115 and 81125 apply)

Clause 3.1.10 of Schedule 3 (item 93286, column 2, paragraph)

Omit “of the Allied Health Determination”.

Schedule 4 (title)

Omit “midwife”, substitute “participating midwife,”.

Health Insurance (Section 3C Pathology Services – Point-of-Care Testing Services) Determination 2024

Section 4 (definition of eligible Aboriginal and Torres Strait Islander health practitioner)

After “Allied Health”, insert “and other Primary Health Care”.

Section 4 (definition of eligible Aboriginal health worker)

Repeal the definition, substitute:

eligible Aboriginal and Torres Strait Islander health worker has the same meaning as in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.

Section 4 (definition of health professional)

Repeal the definition, substitute:

health professional means a practice nurse, eligible Aboriginal and Torres Strait Islander health practitioner or eligible Aboriginal and Torres Strait Islander health worker.