AUSTRALIAN GOVERNMENT

DEPARTMENT OF HEALTH AND AGED CARE

HEALTH INSURANCE ACT 1973

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction (No. 1) 2025

I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Programs Branch, Medicare Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Aged Care, acting under subsection 19(2) of the Health Insurance Act 1973 (the Act), hereby:

REPEAL the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction (No. 3) 2024; and
DIRECT that Medicare Benefits shall be payable in respect of:

A professional service (as defined in Section 3 of the Act) which has been agreed to be provided under the Memorandum of Understanding (MOU) between the Department of Health and Aged Care (ABN: 83 605 426 759) and South Australia (ABN: 52 786 403 404) dated 19 May 2022 as part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative relating to primary care services for which:
1. items specified in Schedule A of this Direction; and of the general medical services table (means the table prescribed under subsection 4(1) of the Act), diagnostic imaging services table (means the table prescribed under subsection 4AA(1) of the Act) or pathology services table (means the table prescribed under subsection 4A(1) of the Act) relates; and
Where the professional service is provided to:
1. an eligible person (as defined in Section 3 of the Act); and
2. a patient who is not part of an episode of hospital treatment (as defined in Section 121-5 of the Private Health Insurance Act 2007); and
The professional service referred to in paragraph (2)(a):
1. is provided at an approved Modified Monash Model 5-7 area (as defined in Section 7.1.1 of the general medical services table) practice location specified in Schedule B; and
2. is either:
  1. a professional non-referred service provided by a state remunerated prescribed medical practitioner, participating midwife, or participating nurse practitioner; or
  2. a professional referred service provided by a state remunerated allied health professional or dental practitioner.

DECLARE that this Direction commences on 24 January 2025 and ceases to have effect at the end of 30 June 2025 unless earlier revoked.

Note, a number of expressions used in this direction are defined in the below instruments:

Health Insurance Act 1973: the meaning of dental practitioner, participating midwife, participating nurse practitioner, and professional service; and
Health Insurance (General Medical Services Table) Regulations 2021: the meaning of prescribed medical practitioner.
Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024: the meaning of allied health professional.

Date: 23 January 2025

Nigel Murray

Assistant Secretary

MBS Policy and Specialist Programs Branch

Medicare Benefits and Digital Health Division

Health Resourcing Group

Department of Health and Aged Care

SCHEDULE A

MEDICARE BENEFITS SCHEDULE ITEMS AT Approved Practice Locations AS AGREED under the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – south australia

For services listed in the below tables, all provisions of the Health Insurance Act 1973 (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 apply.

General Medical Services Table

Group	Group Name	Subgroup	Subgroup Name
A1	General practitioner attendances to which no other item applies
A2	Other non‑referred attendances to which no other item applies
A5	Prolonged attendances to which no other item applies
A6	Group therapy
A7	Acupuncture and non‑specialist practitioner items
A9	Contact lenses
A10	Optometric services provided by optometrist
A11	Urgent attendances after—hours
A14	Health assessments
A15	GP management plans, team care arrangements and multidisciplinary care plans and case conferences	1	GP management plans, team care arrangements and multidisciplinary care plans
A17	Domiciliary and residential medication management reviews
A20	Mental health care
A22	General practitioner after‑hours attendances to which no other item applies
A23	Other non‑referred after‑hours attendances to which no other item applies
A27	Pregnancy support counselling
A35	Non‑referred attendance at a residential aged care facility
A40	Telehealth and phone attendance services	1	General practice telehealth services
		2	General practice phone services
		3	Focussed Psychological Strategies telehealth services
		10	Focussed Psychological Strategies phone services
		11	Health Assessments for Aboriginal and Torres Strait Islander People ‑ Telehealth Service
		13	GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance
		15	GP Pregnancy Support Counselling ‑ Telehealth Service
		16	GP Pregnancy Support Counselling ‑ Phone Service
		19	GP Mental Health Treatment Plan ‑ Telehealth Service
		20	GP Mental Health Treatment Plan ‑ Phone Service
		21	GP Eating Disorder Treatment and Management Plan – Telehealth Service
		27	Eating Disorder Psychological Treatment Services – Telehealth Service
		28	Eating Disorder Psychological Treatment Strategies – Phone Service
		29	GP and Other Medical Practitioner ‑ Urgent After Hours Service in Unsociable Hours ‑ Telehealth Service
		39	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Telehealth Service
		40	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service
M1	Management of bulk‑billed services	1	Management of general bulk‑billed services
		2	General support service
		3	Patients enrolled in MyMedicare
M3	Allied health services
M6	Psychological Therapy Services
M7	Focussed Psychological Strategies (Allied Mental Health)
M8	Pregnancy support counselling
M9	Allied health group services
M10	Complex neurodevelopmental disorder and disability services
M11	Allied health services for Aboriginal and Torres Strait Islander people
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
M14	Nurse practitioners
M15	Diagnostic audiology services
M16	Eating disorders services
M18	Allied health telehealth and phone services	1	Psychological therapies telehealth services
		2	Psychologist focussed psychological strategies telehealth services
		3	Occupational therapist focussed psychological strategies telehealth services
		4	Social worker focussed psychological strategies telehealth services
		5	Nurse practitioner telehealth services
		6	Psychological therapies phone services
		7	Psychologist focussed psychological strategies phone service
		8	Occupational therapist focussed psychological strategies phone services
		9	Social worker focussed psychological strategies phone services
		10	Nurse practitioner phone services
		11	General allied health telehealth services
		12	General allied health phone services
		13	Pregnancy support counselling telehealth services
		14	Pregnancy support counselling phone services
		15	Complex neurodevelopmental disorder and disability telehealth services
		16	Complex neurodevelopmental disorder and disability phone services
		17	Telehealth attendance to person of Aboriginal and Torres Strait Islander descent
		18	Phone attendance to person of Aboriginal and Torres Strait Islander descent
		23	Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner – Telehealth Services
		25	Allied health, group dietetics telehealth services
		26	Allied health, group dietetics phone services
T1	Miscellaneous therapeutic procedures	6	Gastroenterology

General Medical Services Table – permitted items

Group	Group Name	Items	Item overview
A15	GP management plans, team care arrangements and multidisciplinary care plans	735, 739, 743, 747-758, 930-945	Case conferences
A29	Attendance services for complex neurodevelopmental disorder or disability	139	Professional attendance by a general practitioner for assessment, diagnosis and preparation of a treatment and management plan for a patient with an eligible disability
A36	Eating disorder services	90250-90257, 90264, 90265, 90271-90282	Eating disorder services provided by General Practitioners or Medical Practitioners
A40	Telehealth and phone attendance services	92142, 92170, 92171, 92176, 92177	General Practitioner and Prescribed Medical Practitioner items
A44	General Practice attendance for assessing patient suitability for a COVID-19 vaccine	93645, 93647, 93654, 93656, 93661, 93666, 10660, 10661	General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine
D1	Miscellaneous diagnostic procedures and investigations	11300-11318, 11505, 11506, 11602-11615, 11707, 11729, 11730, 12001-12004, 12012, 12017, 12200, 12306, 12312, 12315, 12320-12322, 12325, 12326	Non-referred services only
D2	Nuclear medicine (non‑imaging)	12500, 12524, 12527	Nuclear Medicine (non-imaging)
M13	Midwifery services	82100-82115, 82130-82140	Midwifery items
T1	Miscellaneous therapeutic procedures	13105, 14206	Haemodialysis provided by a registered nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner in a very remote location Hormone or living tissues implantation by cannula
T4	Obstetrics	16400, 16406-16500, 16502-16514, 16530, 16590, 16591, 91850-91858	Antenatal and postnatal attendances
T8	Surgical operations	30003, 30006, 30023, 30026-30055, 30061-30072, 30107, 30192-30207, 30216, 30219, 31356, 32072, 32147, 35503, 41500, 47015, 47042, 47057, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466, 47471, 47543, 47561, 47579, 47595, 47663, 47735, 47904, 47915, 47916, 47918	Minor surgical procedures
O1	Consultations	51700-51703, 54001-54004	Dental practitioner attendances

Diagnostic Imaging Services Table

Group	Group Name
I1	ultrasound
I3	diagnostic radiology
I6	management of bulk‑billed services

Pathology Services Table

Group	Group Name
P9	simple basic pathology tests
P12	management of bulk‑billed services
P13	bulk‑billing incentive

SCHEDULE B

Approved Practice Locations AS AGREED under the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia

Approved locations:

Location	Practice Name	Legal Name	Street Address	Mailing Address
Ceduna	Ceduna District Health Service and Ceduna Family Medical Practice	Eyre and Far North Local Health Network Inc	3 Eyre Highway, Ceduna SA 5690	PO Box 178 Ceduna SA 5690
Cleve (Outreach service of Ceduna)	Mid Eyre Medical Practice – Cleve	Eyre and Far North Local Health Network Inc	15 Main Street, Cleve SA 5640	PO Box 178 Ceduna SA 5690
Coober Pedy (Outreach service of Ceduna)	Coober Pedy Hospital and Coober Pedy Medical Practice	Eyre and Far North Local Health Network Inc	89 McDougall Street, Coober Pedy SA 5723	PO Box 178 Ceduna SA 5690
Cowell (Outreach service of Ceduna)	Cowell Hospital and Mid Eyre Medical Practice – Cowell	Eyre and Far North Local Health Network Inc	17 South Terrace, Cowell SA 5602	PO Box 178 Ceduna SA 5690
Elliston (Outreach service of Ceduna)	Elliston Hospital and Mid Eyre Medical Practice – Elliston	Eyre and Far North Local Health Network Inc	1 Memorial Drive, Elliston SA 5670	PO Box 178 Ceduna SA 5690
Karoonda	Karoonda and District Soldiers’ Memorial Hospital & Mallee Medical Practice - Karoonda	Riverland Mallee Coorong Local Health Network Inc	13 Stokes Road, Karoonda SA 5307	PO Box 145 Karoonda SA 5307
Kimba (Outreach service of Ceduna)	Mid Eyre Medical Practice – Kimba	Eyre and Far North Local Health Network Inc	34 Park Terrace, Kimba SA 5641	PO Box 178 Ceduna SA 5690
Lameroo	Mallee Medical Practice, Lameroo	Riverland Mallee Coorong Local Health Network Inc	1 Vardon Terrace, Lameroo SA 5302	1 Vardon Terrace Lameroo, SA, 5302
Pinnaroo	Pinnaroo Soldiers’ Memorial Hospital	Riverland Mallee Coorong Local Health Network Inc	Bundey Terrace, Pinnaroo SA 5304	PO Box 234 Pinnaroo SA 5304
Pinnaroo (Outreach service of Pinnaroo)	Mallee Medical Practice, Pinnaroo	Riverland Mallee Coorong Local Health Network Inc	1 Gilbert Avenue, Pinnaroo SA 5304	1 Gilbert Avenue, Pinnaroo SA 5304
Wallaroo	Wallaroo Hospital and Health Service	Yorke and Northern Local Health Network Inc	1 Ernest Terrace, Wallaroo SA 5556	1 Ernest Terrace Wallaroo SA 5556