This instrument is the Health Insurance Legislation Amendment (2026 Measures No. 2) Regulations 2026.

(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.

Commencement information
Column 1	Column 2	Column 3
Provisions	Commencement	Date/Details
1. Sections 1 to 4 and anything in this instrument not elsewhere covered by this table	1 July 2026.	1 July 2026
2. Schedule 1	1 July 2026.	1 July 2026
3. Schedule 2, items 1 to 7	1 July 2026.	1 July 2026
4. Schedule 2, items 8 to 15	Immediately after the commencement of the provisions covered by table item 2.	1 July 2026
5. Schedule 3	1 July 2026.	1 July 2026
6. Schedule 4, Part 1	1 July 2026.	1 July 2026
7. Schedule 4, Part 2	Immediately after the commencement of the provisions covered by table item 2.	1 July 2026
8. Schedule 4, Part 3, Division 1	1 July 2026.	1 July 2026
9. Schedule 4, Part 3, Division 2	Immediately after the commencement of the provisions covered by table item 2.	1 July 2026
10. Schedule 5	1 July 2026.	1 July 2026

Note: This table relates only to the provisions of this instrument as originally made.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

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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

1 Clause 2.7.1 of Schedule 1 (heading)

Omit “1 July 2025”, substitute “1 July 2026”.

2 Subclause 2.7.1(1) of Schedule 1

Repeal the subclause, substitute:

(1) At the start of 1 July 2026 (the indexation time), each amount covered by subclause (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department’s MBS Online website (https://www.health.gov.au).

Health Insurance (General Medical Services Table) Regulations 2021

3 Paragraph 1.2.4(2)(c) of Schedule 1

Omit “$349.95”, substitute “$359.05”.

4 Clause 1.3.1 of Schedule 1 (heading)

Omit “1 July 2025”, substitute “1 July 2026”.

5 Subclause 1.3.1(1) of Schedule 1

Repeal the subclause, substitute:

(1) At the start of 1 July 2026 (the indexation time), each amount covered by subclause (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department’s MBS Online website (https://www.health.gov.au).

6 Clause 2.1.1 of Schedule 1 (table 2.1.1)

Repeal the table, substitute:

Table 2.1.1—Amount under clause 2.1.1
Item	Column 1 Item of this Schedule	Column 2 Fee	Column 3 Amount if not more than 6 patients (to be divided by the number of patients) ($)	Column 4 Amount if more than 6 patients ($)
1	4	The fee for item 3	31.50	2.50
2	24	The fee for item 23	31.50	2.50
3	37	The fee for item 36	31.50	2.50
4	47	The fee for item 44	31.50	2.50
5	58	$8.50	15.50	0.70
6	59	$16.00	17.50	0.70
7	60	$35.50	15.50	0.70
8	65	$57.50	15.50	0.70
9	124	The fee for item 123	31.50	2.50
10	165	$88.20	15.50	0.70
11	195	The fee for item 193	31.10	2.45
12	414	The fee for item 410	31.00	2.45
13	415	The fee for item 411	31.00	2.45
14	416	The fee for item 412	31.00	2.45
15	417	The fee for item 413	31.00	2.45
16	5003	The fee for item 5000	31.10	2.45
17	5010	The fee for item 5000	55.95	4.00
18	5023	The fee for item 5020	31.10	2.45
19	5028	The fee for item 5020	55.95	4.00
20	5043	The fee for item 5040	31.10	2.45
21	5049	The fee for item 5040	55.95	4.00
22	5063	The fee for item 5060	31.10	2.45
23	5067	The fee for item 5060	55.95	4.00
24	5076	The fee for item 5071	31.10	2.45
25	5077	The fee for item 5071	55.95	4.00
26	5220	$18.50	15.50	0.70
27	5223	$26.00	17.50	0.70
28	5227	$45.50	15.50	0.70
29	5228	$67.50	15.50	0.70
30	5260	$18.50	27.95	1.25
31	5261	$112.20	15.50	0.70
32	5262	$112.20	27.95	1.25
33	5263	$26.00	31.55	1.25
34	5265	$45.50	27.95	1.25
35	5267	$67.50	27.95	1.25
36	90272	The fee for item 90271	31.10	2.45
37	90274	The fee for item 90273	31.10	2.45
38	90276	The fee for item 90275	24.85	1.95
39	90278	The fee for item 90277	24.85	1.95

7 Clause 2.1.2 of Schedule 1 (table 2.1.2)

Repeal the table, substitute:

Table 2.1.2—Amount under clause 2.1.2
Item	Column 1 Item of this Schedule	Column 2 Fee	Column 3 Amount if not more than 6 patients (to be divided by the number of patients) ($)	Column 4 Amount if more than 6 patients ($)
1	181	The fee for item 179	25.25	2.00
2	187	The fee for item 185	25.25	2.00
3	191	The fee for item 189	25.25	2.00
4	206	The fee for item 203	25.25	2.00
5	303	The fee for item 301	25.25	2.00

8 Schedule 1 (item 111, column 2, paragraph (d))

Omit “$349.95”, substitute “$359.05”.

9 Schedule 1 (item 115, column 2, paragraph (c))

Omit “$349.95”, substitute “$359.05”.

10 Schedule 1 (item 117, column 2, paragraph (e))

Omit “$349.95”, substitute “$359.05”.

11 Schedule 1 (item 120, column 2, paragraph (d))

Omit “$349.95”, substitute “$359.05”.

12 Subclause 2.20.2(1) of Schedule 1 (table 2.20.2)

Repeal the table, substitute:

Table 2.20.2—Amount under clause 2.20.2
Item	Column 1 Item of this Schedule	Column 2 Fee	Column 3 Amount if not more than 6 patients (to be divided by the number of patients) ($)	Column 4 Amount if more than 6 patients ($)
1	2723	The fee for item 2721	31.10	2.45
2	2727	The fee for item 2725	31.10	2.45
3	2741	The fee for item 2739	31.10	2.45
4	2745	The fee for item 2743	31.10	2.45

13 Subclause 2.20.2A(1) of Schedule 1 (table 2.20.2A)

Repeal the table, substitute:

Table 2.20.2A—Amount under clause 2.20.2A
Item	Column 1 Item of this Schedule	Column 2 Fee	Column 3 Amount if not more than 6 patients (to be divided by the number of patients) ($)	Column 4 Amount if more than 6 patients ($)
1	285	The fee for item 283	24.90	1.95
2	287	The fee for item 286	24.90	1.95
3	311	The fee for item 309	24.90	1.95
4	315	The fee for item 313	24.90	1.95

14 Subclause 2.30.1(1) of Schedule 1

Omit “$64.15”, substitute “$65.80”.

15 Subclause 2.30.1(2) of Schedule 1

Omit “$46.60”, substitute “$47.80”.

16 Subclause 5.7.1(1) of Schedule 1 (paragraph (b) of the definition of amount under clause 5.7.1)

Omit “$22.15”, substitute “$22.75”.

17 Subclause 5.7.1(2) of Schedule 1 (paragraph (b) of the definition of amount under clause 5.7.1)

Omit “$33.40”, substitute “$34.25”.

18 Clause 5.9.1A of Schedule 1 (definition of base unit)

Omit “$23.10”, substitute “$23.70”.

19 Schedule 1 (items 51300, 51303, 51800 and 51803, column 2)

Omit “$651.30” (wherever occurring), substitute “$668.25”.

Health Insurance (Pathology Services Table) Regulations 2020

20 Clause 2.14.1 of Schedule 1 (heading)

Omit “1 July 2025”, substitute “1 July 2026”.

21 Subclause 2.14.1(1) of Schedule 1

Repeal the subclause, substitute:

(1) At the start of 1 July 2026 (the indexation time), each amount covered by subclause (1A) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department’s MBS Online website (https://www.health.gov.au).

Schedule 2—Other diagnostic imaging services amendments

Part 1—Amendments relating to breast imaging services

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

1 Subclause 1.2.21(10) of Schedule 1

Repeal the subclause, substitute:

(10) This clause also does not apply to the fee specified in item 59103, 64990, 64991, 64992, 64993, 64994 or 64995.

(10A) Subclause (1) also does not apply to the fee specified in item 55066, 55070, 55071, 55073, 55076, 55079, 59300, 59302, 59303, 59305, 59312, 59314, 59318 or 63464.

2 Schedule 1 (item 55066, column 2, paragraph (b))

Omit “any other item in this Group”, substitute “a service to which any other item in this Group applies (other than item 55070, 55071, 55073, 55076, 55079 or 55812)”.

3 Schedule 1 (item 55071, column 2, paragraph (b))

Omit “any other item in this group”, substitute “a service to which any other item in this Group applies (other than item 55066, 55070, 55073, 55076, 55079 or 55812)”.

4 Schedule 1 (item 55812, column 2)

Omit “, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079”.

5 Schedule 1 (item 63464, column 2, subparagraph (c)(v))

Omit “; and”.

6 Schedule 1 (item 63464, column 2, paragraph (d))

Repeal the paragraph.

Part 2—Other amendments

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

7 Schedule 1 (item 55133, column 2, subparagraph (a)(ii))

Omit “has a normal baseline study, and has commenced medication for non‑cardiac purposes”, substitute “has commenced medication”.

8 Schedule 1 (item 61325, column 3)

Omit “340.50”, substitute “1,949.45”.

9 Schedule 1 (item 61429, column 3)

Omit “562.00”, substitute “1,636.50”.

10 Schedule 1 (item 61430, column 3)

Omit “682.55”, substitute “1,763.20”.

11 Schedule 1 (item 61438, column 3)

Omit “696.50”, substitute “2,323.50”.

12 Schedule 1 (item 61442, column 3)

Omit “778.70”, substitute “1,864.20”.

13 Schedule 1 (item 61450, column 3)

Omit “411.45”, substitute “1,478.30”.

14 Schedule 1 (item 61453, column 3)

Omit “532.70”, substitute “1,605.75”.

15 Schedule 1 (item 61461, column 3)

Omit “546.30”, substitute “2,165.70”.

Schedule 3—Other pathology services amendments

Health Insurance (Pathology Services Table) Regulations 2020

1 Schedule 1 (cell at item 65150, column 2)

Repeal the cell, substitute:

Assessment of von Willebrand factor, factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, factor XIII, prekallikrein, high‑molecular‑weight kininogen, circulating coagulation factor inhibitors other than by Bethesda assay—one test

2 Schedule 1 (item 69499, column 2, paragraph (a))

Repeal the paragraph, substitute:

(a) the patient is hepatitis C seropositive; or

(aa) the patient’s hepatitis C serological status is uncertain after an inconclusive serology test result; or

3 Schedule 1 (after item 73399)

Insert:

73400

Genetic testing for at least 2 HLA variants to predict the patient’s risk of a severe drug hypersensitivity reaction to carbamazepine or oxcarbazepine, if the service is conducted before or during the initiation of treatment with carbamazepine or oxcarbazepine

Applicable once per lifetime

139.00

Schedule 4—Other general medical services amendments

Part 1—Amendments relating to treatment of acute burn wounds

Health Insurance (General Medical Services Table) Regulations 2021

1 Schedule 1 (item 46100, column 2, paragraph (b))

Omit “items 46101 to 46135 (other than item 46112 or 46124)”, substitute “items 46101 to 46111, 46113 to 46123 and 46125 to 46135”.

2 Schedule 1 (item 46100, column 2)

Omit “item 46136”, substitute “item 46112, 46124 or 46136”.

3 Schedule 1 (item 46112, column 2)

Omit “other than a service associated with a service to which item 46100 applies and”.

4 Schedule 1 (item 46113, column 2)

Omit “if the defect area is not more than 1% of total body surface and”, substitute “to an area of less than 1% of total body surface,”.

5 Schedule 1 (item 46113, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or

(B) for a patient aged 15 years or over—at least 20% of total body surface; or

(iii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

6 Schedule 1 (item 46114, column 2)

Omit “if the defect area is more than 1% but not more than 3% of total body surface and”, substitute “to an area of at least 1% but less than 3% of total body surface,”.

7 Schedule 1 (item 46114, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(A) for a patient aged less than 15 years—at least 10% of total body surface; or

(B) for a patient aged 15 years or over—at least 20% of total body surface; or

(iii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

8 Schedule 1 (item 46115, column 2)

Omit “if the defect area is more than 3% but not more than 10% of total body surface and”, substitute “to an area of at least 3% but less than 10% of total body surface,”.

9 Schedule 1 (item 46115, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(A) for a patient aged less than 15 years—at least 10% of total body surface; or

(B) for a patient aged 15 years or over—at least 20% of total body surface; or

(iii) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound

10 Schedule 1 (item 46116, column 2)

Omit “if the defect area is more than 10% but less than 20% of total body surface and”, substitute “to an area of at least 10% but less than 20% of total body surface,”.

11 Schedule 1 (item 46116, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) for a patient aged less than 15 years—autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iii) for a patient aged 15 years or over—autologous skin cell suspension for definitive closure, or autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure, if the total area being treated in the procedure is at least 20% of total body surface; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

12 Schedule 1 (item 46117, column 2)

Omit “if the defect area is 20% or more but less than 30% of total body surface and”, substitute “to an area of at least 20% but less than 30% of total body surface,”.

13 Schedule 1 (item 46117, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

14 Schedule 1 (item 46118, column 2)

Omit “if the defect area is 30% or more but less than 40% of total body surface and”, substitute “to an area of at least 30% but less than 40% of total body surface,”.

15 Schedule 1 (item 46118, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

16 Schedule 1 (item 46119, column 2)

Omit “if the defect area is 40% or more but less than 50% of total body surface and”, substitute “to an area of at least 40% but less than 50% of total body surface,”.

17 Schedule 1 (item 46119, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

18 Schedule 1 (item 46120, column 2)

Omit “if the defect area is 50% or more but less than 60% of total body surface and”, substitute “to an area of at least 50% but less than 60% of total body surface,”.

19 Schedule 1 (item 46120, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

20 Schedule 1 (item 46121, column 2)

Omit “if the defect area is 60% or more but less than 70% of total body surface and”, substitute “to an area of at least 60% but less than 70% of total body surface,”.

21 Schedule 1 (item 46121, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

22 Schedule 1 (item 46122, column 2)

Omit “if the defect area is 70% or more but less than 80% of total body surface and”, substitute “to an area of at least 70% but less than 80% of total body surface,”.

23 Schedule 1 (item 46122, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

24 Schedule 1 (item 46123, column 2)

Omit “if the defect area is 80% or more of total body surface and”, substitute “to an area of at least 80% of total body surface,”.

25 Schedule 1 (items 46123 and 46124, column 2, paragraph (b))

Repeal the paragraph, substitute:

(b) involves:

(i) autologous skin grafting for definitive closure; or

(ii) autologous skin cell suspension for definitive closure; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting for definitive closure; or

(iv) allogenic skin grafting, or biosynthetic skin substitutes, to temporize the excised wound;

26 Schedule 1 (item 46124, column 2)

Omit “, other than a service associated with a service to which item 46100 applies”.

27 Schedule 1 (cell at item 46130, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving less than 1% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or

(B) for a patient aged 15 years or over—at least 20% of total body surface

(H) (Anaes.) (Assist.)

28 Schedule 1 (cell at item 46131, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving at least 1% but less than 3% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or

(B) for a patient aged 15 years or over—at least 20% of total body surface

(H) (Anaes.) (Assist.)

29 Schedule 1 (cell at item 46132, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving at least 3% but less than 10% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is:

(A) for a patient aged less than 15 years—at least 10% of total body surface; or

(B) for a patient aged 15 years or over—at least 20% of total body surface

(H) (Anaes.) (Assist.)

30 Schedule 1 (cell at item 46133, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis or secondary to release of burns scar contracture, to an area involving at least 10% but less than 20% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure or simple dressings; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) for a patient aged less than 15 years—autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting; or

(iii) for a patient aged 15 years or over—autologous skin cell suspension, or autologous skin cell suspension in conjunction with autologous skin grafting, if the total area being treated in the procedure is at least 20% of total body surface;

(excluding aftercare) (H) (Anaes.) (Assist.)

31 Schedule 1 (cell at item 46134, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, to an area involving at least 20% but less than 30% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) autologous skin cell suspension; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H) (Anaes.) (Assist.)

32 Schedule 1 (cell at item 46135, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, to an area involving at least 30% of total body surface, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) autologous skin cell suspension; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H) (Anaes.) (Assist.)

33 Schedule 1 (cell at item 46136, column 2)

Repeal the cell, substitute:

Definitive burn wound closure, or closure of skin defect secondary to necrotising fasciitis, of whole face, if the service:

(a) is provided following a previous procedure that used non‑autologous temporary wound closure; and

(b) involves:

(i) autologous tissue (split skin graft or other); or

(ii) autologous skin cell suspension; or

(iii) autologous skin cell suspension in conjunction with autologous skin grafting;

(excluding aftercare) (H) (Anaes.) (Assist.)

Part 2—Amendments relating to sleep investigations

Health Insurance (General Medical Services Table) Regulations 2021

34 Subclause 1.2.11(1) of Schedule 1

After “12217,”, insert “12218, 12219,”.

35 Schedule 1 (item 11000, column 2, after paragraph (b))

Insert:

; or (c) to which item 12218 or 12219 applies

36 Schedule 1 (at the end of the cell at item 11003, column 2)

Add:

; or (e) to which item 12218 or 12219 applies

37 Schedule 1 (at the end of the cell at item 11004, column 2)

Add:

; or (c) to which item 12218 or 12219 applies

38 Schedule 1 (at the end of the cell at item 11005, column 2)

Add:

; or (c) to which item 12218 or 12219 applies

39 Schedule 1 (item 11503, column 2)

After “item 11507”, insert “, 12218 or 12219”.

40 Schedule 1 (at the end of the cell at item 11704, column 2)

Add:

; and (c) is not a service to which item 12218 or 12219 applies

41 Schedule 1 (item 11705, column 2, after paragraph (b))

Insert:

; and (c) is not a service to which item 12218 or 12219 applies

42 Schedule 1 (item 11707, column 2, after paragraph (b))

Insert:

; and (c) the service is not a service to which item 12218 or 12219 applies

43 Schedule 1 (at the end of the cell at item 11713, column 2)

Add “, other than a service to which item 12218 or 12219 applies”.

44 Schedule 1 (item 11714, column 2, after paragraph (d))

Insert:

; and (e) the service is not a service to which item 12218 or 12219 applies

45 Schedule 1 (item 11716, column 2, after paragraph (e))

Insert:

; and (f) is not a service to which item 12218 or 12219 applies

46 Schedule 1 (item 11717, column 2, after paragraph (d))

Insert:

; and (e) is not a service to which item 12218 or 12219 applies

47 Schedule 1 (item 11723, column 2, after paragraph (d))

Insert:

; and (e) is not a service to which item 12218 or 12219 applies

48 Schedule 1 (item 11735, column 2, at the end of paragraph (d))

Add:

; or (iii) to which item 12218 or 12219 applies

49 Schedule 1 (item 12210, column 2)

Omit “each of the first 3 occasions the investigation is performed”, substitute “the first 3 investigations to which this item or item 12218 applies”.

50 Schedule 1 (item 12213, column 2)

Omit “each of the first 3 occasions the investigation is performed”, substitute “the first 3 investigations to which this item or item 12210, 12218 or 12219 applies”.

51 Schedule 1 (item 12215, column 2, paragraph (g))

Omit “to which item 12210 applies”, substitute “in which item 12210 or 12218 applies”.

52 Schedule 1 (item 12215, column 2, subparagraphs (g)(i) and (ii))

After “item 12210”, insert “or 12218”.

53 Schedule 1 (item 12215, column 2)

Omit “only once in the same 12 month period to which item 12210 applies”, substitute “once in the 12 month period that starts when the first of the 3 studies mentioned in subparagraph (g)(i) or (ii) is provided”.

54 Schedule 1 (item 12217, column 2, paragraph (g))

Omit “to which item 12213 applies”, substitute “in which item 12210, 12213, 12218 or 12219 applies”.

55 Schedule 1 (item 12217, column 2, subparagraphs (g)(i) and (ii))

Omit “item 12213”, substitute “any of items 12210, 12213, 12218 and 12219”.

56 Schedule 1 (item 12217, column 2)

Omit “only once in the same 12 month period to which item 12213 applies”, substitute “once in the 12 month period that starts when the first of the 3 studies mentioned in subparagraph (g)(i) or (ii) is provided”.

57 Schedule 1 (after item 12217)

Insert:

12218

Overnight investigation of sleep, for at least 8 hours, for a patient aged at least 3 years but less than 12 years, if:

(a) the patient is referred by a medical practitioner to a qualified paediatric sleep medicine practitioner; and

(b) following professional attendance on the patient (either face‑to‑face or by video conference), the qualified paediatric sleep medicine practitioner determines that:

(i) the investigation is necessary for a purpose mentioned in paragraph (c); and

(ii) an unattended sleep study is appropriate for the investigation; and

(i) to confirm diagnosis of sleep apnoea;

(ii) as a repeat investigation to assess treatment effectiveness;

(iii) as a repeat investigation to determine respiratory support needs following a significant change in clinical status; and

(d) during a period of sleep, there is continuous monitoring and recording of at least the following measures:

(i) airflow;

(ii) EMG;

(iii) ECG or heart rate;

(iv) EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(e) the investigation is provided:

(i) under the supervision of a qualified paediatric sleep medicine practitioner; and

(ii) in accordance with current professional guidelines (including in relation to interpreting polygraphic data and preparing a report); and

(f) before the investigation commences, a parent or caregiver of the patient is given:

(i) written or video instructions on how to monitor the patient overnight; and

(ii) a way of contacting a sleep technician to enable trouble shooting overnight; and

(g) the equipment is applied to the patient by:

(i) a sleep technician; or

(ii) the parent or caregiver of the patient if:

(A) before the set‑up process commences, the parent or caregiver is given written or video instructions for how to apply the equipment; and

(B) there is continuous telehealth support from a sleep technician throughout the set‑up process; and

(h) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and cardiac abnormalities) using manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(i) interpretation and preparation of a permanent report are provided by a qualified paediatric sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient

Applicable in relation to the first 3 investigations to which this item or item 12210 applies in any 12 month period

489.90

12219

Overnight investigation of sleep, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner to a qualified sleep medicine practitioner; and

(b) following professional attendance on the patient (either face‑to‑face or by video conference), the qualified sleep medicine practitioner determines that:

(i) the investigation is necessary for a purpose mentioned in paragraph (c); and

(ii) an unattended sleep study is appropriate for the investigation; and

(i) to confirm diagnosis of sleep apnoea;

(ii) as a repeat investigation to assess treatment effectiveness;

(iii) as a repeat investigation to determine respiratory support needs following a significant change in clinical status; and

(d) during a period of sleep, there is continuous monitoring and recording of at least the following measures:

(i) airflow;

(ii) EMG;

(iii) ECG or heart rate;

(iv) EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(e) the investigation is provided:

(i) under the supervision of a qualified sleep medicine practitioner; and

(ii) in accordance with current professional guidelines (including in relation to interpreting polygraphic data and preparing a report); and

(f) before the investigation commences, a parent or caregiver of the patient is given:

(i) written or video instructions on how to monitor the patient overnight; and

(ii) a way of contacting a sleep technician to enable trouble shooting overnight; and

(g) the equipment is applied to the patient by:

(i) a sleep technician; or

(ii) the parent or caregiver of the patient if:

(A) before the set‑up process commences, the parent or caregiver is given written or video instructions for how to apply the equipment; and

(B) there is continuous telehealth support from a sleep technician throughout the set‑up process; and

(h) polygraphic records are:

(ii) stored for interpretation and preparation of a report; and

(i) interpretation and preparation of a permanent report are provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient

Applicable in relation to the first 3 investigations to which this item or item 12210, 12213 or 12218 applies in any 12 month period

455.25

Part 3—Other amendments

Division 1—Amendments commencing the same time as Schedule 1

Health Insurance (General Medical Services Table) Regulations 2021

58 Clause 2.11.3 of Schedule 1

Omit “, 319 or 92436”, substitute “or 319”.

59 Schedule 1 (item 294, column 2, paragraph (b))

Omit “, 319, 92436 or 92444”, substitute “or 319”.

60 Clause 2.16.11 of Schedule 1 (heading)

Omit “9206 and”, substitute “92060 and”.

61 Clause 2.16.11 of Schedule 1

Omit “9206 and”, substitute “92060 and”.

62 Subclause 2.31.7(3) of Schedule 1

Omit “, 735 to 758, 92115, 92121, 92127 and 92133”, substitute “and 735 to 758”.

63 Subclause 2.31.7(5) of Schedule 1

Repeal the subclause.

64 Schedule 1 (item 15944, column 2)

After “once per day”, insert “per site, for a maximum of 2 sites”.

65 Schedule 1 (item 32150, column 2)

Omit “, injection of Botulinum toxin”.

66 Schedule 1 (cell at item 38511, column 2)

Repeal the cell, substitute:

Coronary artery bypass, with the aid of tissue stabilisers, if:

(a) the service is performed without cardiopulmonary bypass; and

(b) the service is performed in conjunction with a service to which item 38502 applies

Applicable only once in conjunction with each service to which item 38502 applies (H) (Anaes.) (Assist.)

67 Schedule 1 (item 45761, column 2, paragraphs (a) and (b))

Repeal the paragraphs, substitute:

(a) the deformity:

(i) is secondary to congenital absence of tissue; or

(ii) is the result of a diagnosed craniofacial disorder; or

(iii) has arisen from trauma (other than from previous cosmetic surgery) or a diagnosed pathological process; and

(b) for a craniofacial disorder—evidence of diagnosis of the disorder is documented in the patient notes; and

68 Schedule 1 (item 45888, column 2)

After “(H)”, insert “(Anaes.) (Assist.)”.

69 Schedule 1 (item 45891, column 2)

After “flap”, insert “(Anaes.) (Assist.)”.

70 Schedule 1 (item 45939, column 2)

After “(H)”, insert “(Anaes.) (Assist.)”.

71 Clause 5.10.25 of Schedule 1

Repeal the clause.

72 Schedule 1 (items 50200 and 50201, column 2)

After “excluding aftercare”, insert “, if the service has not already applied to the patient twice in the preceding 12 months for a service provided by the same provider”.

Division 2—Amendments commencing after Schedule 1 commences

Health Insurance (General Medical Services Table) Regulations 2021

73 Schedule 1 (items 32084 and 32087, column 2)

Before “32222”, insert “32219,”.

74 Schedule 1 (before item 32222)

Insert:

32219

Endoscopic examination of the colon to the caecum by colonoscopy, for an asymptomatic patient following a positive result from a faecal occult blood test undertaken for screening purposes

Applicable once per day under a single episode of anaesthesia or other sedation (H) (Anaes.)

400.20

75 Schedule 1 (item 32222, column 2, paragraphs (a) to (h))

Repeal the paragraphs, substitute:

(a) who has symptoms consistent with pathology of the colonic mucosa; or

(b) who has anaemia or iron deficiency; or

(d) who is undergoing the first examination following surgery for colorectal cancer; or

(e) who is undergoing pre‑operative evaluation; or

(f) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(g) for the management of inflammatory bowel disease;

76 Schedule 1 (items 32228 and 32229, column 2)

Before “32222”, insert “32219,”.

77 Schedule 1 (after item 45062)

Insert:

45070

Developmental breast abnormality, single stage correction of, involving surgery on one breast, if:

(a) the correction involves either:

(i) insertion of an implant with or without mastopexy; or

(ii) reduction mammaplasty; and

(b) there is a difference in breast volume with the other breast, as demonstrated by an appropriate volumetric measurement technique, of at least:

(i) 20% in normally shaped breasts; or

(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds; and

(c) photographic or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

1,014.40

45071

Developmental breast abnormality, 2 stage correction of, first stage, involving surgery on one breast with insertion of a tissue expander, if:

(a) there is a difference in breast volume with the other breast, as demonstrated by an appropriate volumetric measurement technique, of at least:

(i) 20% in normally shaped breasts; or

(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds; and

(b) photographic or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

1,014.40

45072

Developmental breast abnormality, 2 stage correction of, second stage, involving surgery on one breast with exchange of a tissue expander for an implant (which must have at least a 10% volume difference), if:

(a) there is a difference in breast volume with the other breast, as demonstrated by an appropriate volumetric measurement technique, of at least:

(i) 20% in normally shaped breasts; or

(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds; and

(b) photographic or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

734.05

Schedule 5—Amendments to Health Insurance Regulations 2018

Health Insurance Regulations 2018

1 Section 44 (cell at table item 1, column 2)

Repeal the cell, substitute:

55036, 55065, 55066, 55070, 55071, 55076, 55080, 55600, 55700, 55704, 55768, 55812, 55844, 55848, 55850, 55852, 55856, 55858, 55860, 55862, 55864, 55866, 55868, 55870, 55872, 55874, 55876, 55878, 55880, 55882, 55884, 55886, 55888, 55890, 55892, 55894