Health Insurance Legislation Amendment (2026 Measures No. 1) Determination 2025

I, Roland Balodis, delegate for the Minister for Health and Ageing, make the following determination.

Dated 22 December 2025

Roland Balodis

Contents

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

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

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

4  Schedules................................................1

Schedule 1—Telehealth Amendments 2

Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 2

Schedule 2—Allied Health Amendments 4

Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024 4

1  Name

  This instrument is the Health Insurance Legislation Amendment (2026 Measures No. 1) 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Note:  This table relates only to the provisions of this instrument as originally made.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  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  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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—Telehealth Amendments

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

1.      Clause 1.1.19 of Schedule 1, Division 1.1 (Group A40 table, subgroup 11, items 92004 and 92011, column 2)

Omit “Only if items 93470 or 93479 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 is also not applicable within that same 9 month period”.

2  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, Subgroup A44 heading)

Omit “A44”, substitute “44”.

3  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92422, column 2, paragraph (c))

Omit “91826 or 91836”, substitute “91826, 91836 or 92440”.

4  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92760, column 2, subparagraph (c)(iii))

Omit “92423 or 92763”, substitute “92423, 92763 or 92443”.

5  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92623, column 2, paragraph (d))

Omit “91826 or 91836”, substitute “91826, 91836 or 92440”.

6  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92762, column 2, paragraph (c))

Repeal the paragraph, substitute:

  “(c) an attendance on the patient to which item 104, 105, 110, 116, 119, 132, 133, 6018, 6019, 6023, 91824, 91825, 91826, 91836, 92422, 92423, 92440, 92443, 92759, 92760 or 92763 applies did not take place on the same day by the same addiction medicine specialist; and”.

7  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92763, column 2, paragraph (c))

Repeal the paragraph, substitute:

“(c) an attendance on the patient to which item 104, 105, 110, 116, 119, 132, 133, 6018, 6019, 6024, 91824, 91825, 91826, 91836, 92422, 92423, 92440, 92443, 92759 or 92760 applies did not take place on the same day by the same addiction medicine specialist; and”.

8  Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92767, column 2, paragraph (c))

Omit “92764, or 92765”, substitute “92440, 92443, 92764 or 92765”.

9 Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92768, column 2)

Omit “patient with at least 2”, substitute “patient with at least two”.

10 Clause 2.1.4 of Schedule 2, Division 2.1 (Group A40 table, item 92768, column 2, paragraph (c))

After “92423,”, insert “92440, 92443,”.

11 Subclause 2.1.3(1) of Schedule 2, Division 2.1

Omit “92422 or 92423”, substitute “92422, 92423, 92440 or 92443”.

12  Subclause 3.1.2(3) of Schedule 3, Division 3.1

Omit “or 91836”, substitute “91836 or 92440”.

13 Paragraph 3.1.5(1)(a) of Schedule 3, Division 3.1

After “92437,”, insert “ 92444, ”.

14 Paragraph 3.1.5(1)(b) of Schedule 3, Division 3.1

Omit “92422 or 92423,”, substitute “92422, 92423, 92440 or 92443”.

Schedule 2—Allied Health Amendments

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

1  Subclause 5.1.2(3) of Schedule 2, Part 5

Omit “91826 or 91836”, substitute “91826, 91836 or 92440”.

2  Subclause 2.1.5(2) of Schedule 2, Part 2

After “92437,” insert “ 92444, ”.

3  Subclause 2.1.5(3) of Schedule 2, Part 2

Omit “ or 92423”, substitute “, 92423, 92440 or 92443”.

4  Paragraph 8.1.3(2)(c) of Schedule 2, Part 8

After “92179”, insert “ or 92441and 92442 ”.