Commonwealth Consolidated Regulations Commonwealth Consolidated RegulationsThis legislation has been repealed.
Select Legislative Instrument No. 248, 2013 as amended
Compilation start date: 18 March 2014
Includes amendments up to: SLI No. 28, 2014
About this compilation
This compilation
This is a compilation of the Health Insurance (General Medical Services Table) Regulation 2013 as in force on 18 March 2014. It includes any commenced amendment affecting the legislation to that date.
This compilation was prepared on 18 March 2014.
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of each amended provision.
Uncommenced amendments
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in the endnotes.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Modifications
If a provision of the compiled law is affected by a modification that is in force, details are included in the endnotes.
Provisions ceasing to have effect
If a provision of the compiled law has expired or otherwise ceased to have effect in accordance with a provision of the law, details are included in the endnotes.
Contents
1............................ Name of regulation............................................................. 1
3............................ Authority............................................................................ 1
4............................ Schedule(s)......................................................................... 1
5............................ General medical services table............................................ 1
6............................ Dictionary........................................................................... 1
Schedule 1--General medical services table 2
Part 1--Preliminary 2
Division 1.1--Interpretation 2
1.1.1...................... Meaning of eligible non-vocationally recognised medical practitioner 2
1.1.1A................... Meaning of general practitioner......................................... 3
1.1.2...................... Meaning of multidisciplinary case conference.................... 4
1.1.3...................... Meaning of multidisciplinary case conference team........... 5
1.1.4...................... Meaning of single course of treatment............................... 6
1.1.5...................... Meaning of symbol (G)...................................................... 7
1.1.6...................... Meaning of symbol (H)...................................................... 7
1.1.7...................... Meaning of symbol (S)....................................................... 7
Division 1.2--General application provisions 9
1.2.1...................... Application......................................................................... 9
1.2.2...................... Attendance by specialist or consultant physician................ 9
1.2.3...................... Professional attendance services......................................... 9
1.2.4...................... Personal attendance by medical practitioners generally..... 10
1.2.5...................... Personal attendance by medical practitioners.................... 11
1.2.6...................... Consultant occupational physician.................................... 12
1.2.7...................... Application of items 3 to 10943........................................ 12
1.2.8...................... Services that may be provided by persons other than medical practitioners 13
1.2.9...................... Meaning of participating in a video conferencing consultation 13
Part 2--Services and fees 14
Division 2.1--Groups A1 to A10 14
2.1.1...................... Meaning of amount under clause 2.1.1............................ 14
Division 2.2--Group A1: General practitioner attendances to which no other item applies 17
Division 2.3--Group A2: Other non-referred attendances to which no other item applies 22
2.3.1...................... Effect of determination under section 106TA of Act........ 22
Division 2.4--Group A3: Specialist attendances to which no other item applies 26
2.4.1...................... Limitation of item 99......................................................... 26
Division 2.5--Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies 29
2.5.1...................... Limitation of items 112 to 114.......................................... 29
Division 2.5A--Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability 33
2.5A.1................... Meanings of eligible allied health provider and risk assessment 33
2.5A.2................... Meaning of eligible disability............................................ 33
Division 2.6--Group A28: Geriatric medicine 37
2.6.1...................... Limitation of item 149....................................................... 37
Division 2.7--Group A5: Prolonged attendances to which no other item applies 42
2.7.1...................... Application of items 160 to 164........................................ 42
Division 2.8--Group A6: Group therapy 43
Division 2.9--Group A7: Acupuncture 44
2.9.1...................... Meaning of qualified medical acupuncturist..................... 44
Division 2.10--Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies 47
2.10.1.................... Application of items 291, 293 and 359............................. 47
2.10.2.................... Application of items 342, 344 and 346............................. 47
2.10.3.................... Restriction of telepsychiatry consultations to regional, rural and remote areas 47
2.10.4.................... Limitation of item 288....................................................... 47
2.10.5.................... Meanings of eligible allied health provider and risk assessment 47
Division 2.11--Group A12: Consultant occupational physician attendances to which no other item applies 62
2.11.1.................... Limitation of items 384 and 389....................................... 62
Division 2.12--Group A13: Public health physician attendances to which no other item applies 65
2.12.1.................... Public health physicians.................................................... 65
Division 2.13--Miscellaneous services 68
Division 2.14--Group A21: Emergency physician attendances to which no other item applies 69
2.14.1.................... Meaning of recognised emergency department................ 69
2.14.2.................... Meaning of problem focussed history.............................. 69
2.14.3.................... Attendance for emergency evaluation of critically ill patients 69
Division 2.15--Group A11: Urgent attendances after hours 73
2.15.1.................... Meaning of patient's medical condition requires urgent treatment 73
2.15.2.................... Meaning of responsible person........................................ 73
2.15.3.................... Application of Group A11................................................ 73
2.15.4.................... Effect of determination under section 106TA of Act........ 74
Division 2.16--Group A14: Health assessments 76
2.16.1.................... Application of Group A14................................................ 76
2.16.2.................... Types of health assessments............................................. 76
2.16.3.................... Application of item 715 to certain patients only................ 78
2.16.4.................... Healthy Kids Check.......................................................... 78
2.16.5.................... Type 2 Diabetes Risk Evaluation...................................... 80
2.16.6.................... 45 year old Health Assessment......................................... 81
2.16.7.................... Older Person's Health Assessment.................................. 82
2.16.8.................... Comprehensive Medical Assessment for permanent resident of residential aged care facility 83
2.16.9.................... Health assessment for a person with an intellectual disability 84
2.16.10.................. Health assessment for a refugee or other humanitarian entrant 86
2.16.11.................. Aboriginal and Torres Strait Islander child health assessment 87
2.16.12.................. Aboriginal and Torres Strait Islander adult health assessment 89
2.16.13.................. Aboriginal and Torres Strait Islander Older Person's Health Assessment 91
2.16.14.................. Restrictions on health assessments for Group A14.......... 92
Division 2.17--Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences 95
Subdivision A--General 95
2.17.1.................... Service by medical practitioners........................................ 95
Subdivision B--Subgroup 1 of Group A15 95
2.17.2.................... Meaning of associated medical practitioner..................... 95
2.17.3.................... Meaning of contribute to a multidisciplinary care plan.... 95
2.17.4.................... Meaning of coordinating the development of team care arrangements 96
2.17.5.................... Meaning of coordinating a review of team care arrangements 97
2.17.6.................... Meaning of multidisciplinary care plan............................ 98
2.17.7.................... Meaning of preparing a GP management plan................ 99
2.17.8.................... Meaning of reviewing a GP management plan................ 99
2.17.9.................... Application of items 721, 723, 729, 731 and 732........... 100
2.17.10.................. Application of items 701 to 723 and 732........................ 101
2.17.11.................. Limitation on items 721, 723, 729, 731 and 732............. 101
Subdivision C--Subgroup 2 of Group A15 105
2.17.12.................. Meaning of multidisciplinary discharge case conference 105
2.17.13.................. Meaning of multidisciplinary case conference in a residential aged care facility 105
2.17.14.................. Meaning of organise and coordinate............................. 105
2.17.15.................. Meaning of participate................................................... 106
2.17.16.................. Meaning of coordinating................................................ 106
2.17.17.................. Meaning of case conference team................................... 107
2.17.18.................. Application of item 880.................................................. 107
Division 2.18--Group A17: Domiciliary and residential medication management reviews 114
2.18.1.................... Meaning of living in a community setting....................... 114
2.18.2.................... Meaning of residential medication management review. 114
2.18.3.................... Application of items 900 and 903................................... 115
Division 2.18A--Group A30: Medical practitioner video conferencing consultation 117
2.18A.1................. Application of items........................................................ 117
2.18A.2................. Application of items 2125, 2138, 2179 and 2220........... 117
2.18A.3................. Meaning of amount under clause 2.18A.3...................... 117
2.18A.4................. Limitation of items.......................................................... 118
Division 2.19--Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non-referral attendances associated with PIP payments to which no other item applies) 124
2.19.1.................... Application of Subgroup 2 of Groups A18 and A19..... 124
2.19.2.................... Application of Subgroup 3 of Groups A18 and A19..... 125
Division 2.20--Group A20: Mental health care 138
2.20.1.................... Definitions...................................................................... 138
2.20.2.................... Meaning of amount under clause 2.20.2........................ 138
2.20.3.................... Meaning of preparation of a GP mental health treatment plan 139
2.20.4.................... Meaning of review of a GP mental health treatment plan 140
2.20.5.................... Meaning of associated medical practitioner................... 141
2.20.6.................... Application of Subgroup 1 of Group A20...................... 142
2.20.7.................... Focussed psychological strategies.................................. 144
Division 2.21--Group A24: Palliative and pain medicine 148
2.21.1.................... Meaning of organise and coordinate............................. 148
2.21.2.................... Meaning of participate................................................... 148
2.21.3.................... Application of Group A24.............................................. 149
2.21.4.................... Limitation on items......................................................... 149
2.21.5.................... Limitation of items.......................................................... 149
Division 2.22--Group A27: Pregnancy support counselling 158
2.22.1.................... Application of item 4001................................................ 158
Division 2.23--Group A22: General practitioner after-hours attendances to which no other item applies 160
2.23.1.................... Application of Group A22.............................................. 160
Division 2.24--Group A23: Other non-referred after-hours attendances to which no other item applies 165
2.24.1.................... Application of Group A23.............................................. 165
Division 2.26--Group A26: Neurosurgery attendances to which no other item applies 168
2.26.1.................... Limitation of items 6004 and 6016................................. 168
Division 2.27--Group A9: Contact lenses 171
2.27.1.................... Application of item 10809.............................................. 171
Division 2.28--Group A10: Optometric services provided by participating optometrist 174
2.28.1.................... Application of items 10900, 10940 and 10941............... 174
2.28.2.................... Application of item 10929.............................................. 174
2.28.3.................... Limitation on items......................................................... 174
2.28.4.................... Application of items 10931, 10932 and 10933............... 175
2.28.5.................... Limitation of item 10943................................................. 175
Division 2.29--Miscellaneous services 182
Division 2.30--Group 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 183
2.30.1.................... Definitions for item 10997.............................................. 183
2.30.2.................... Application of item 10986.............................................. 183
2.30.3.................... Restrictions on item 10986............................................. 184
2.30.4.................... Application of item 10988.............................................. 184
2.30.5.................... Application of item 10989.............................................. 184
2.30.6.................... Limitation of item 10983................................................. 185
Division 2.31--Group M1: Management of bulk-billed services 188
2.31.1.................... Definitions for Division 2.31.......................................... 188
2.31.2.................... Application of items 10990, 10991 and 10992............... 190
Division 2.33--Diagnostic procedures and investigations 192
Division 2.34--Group D1: Miscellaneous diagnostic procedures and investigations 193
2.34.1.................... Meaning of report.......................................................... 193
2.34.2.................... Meaning of qualified sleep medicine practitioner........... 193
2.34.3 .................... Application of Group D1................................................ 195
Division 2.35--Group D2: Nuclear medicine (non-imaging) 218
2.35.1 .................... Application of Group D2................................................ 218
Division 2.37--Group T1: Miscellaneous therapeutic procedures 219
2.37.1.................... Meaning of comprehensive hyperbaric medicine facility 219
2.37.2.................... Meaning of embryology laboratory services.................. 220
2.37.3.................... Meaning of treatment cycle............................................. 220
2.37.4.................... Items provided as part of treatment cycle relating to assisted reproductive services not to apply 220
2.37.5.................... Application of items 13020 to 14245.............................. 220
2.37.6.................... Limitation on item 13104................................................ 221
2.37.7.................... Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances 221
2.37.8.................... Application of items 14227 to 14242.............................. 221
2.37.9.................... Application of item 14245.............................................. 221
2.37.10.................. Limitation of item 13210................................................. 222
Division 2.38--Group T2: Radiation oncology 236
2.38.1.................... Meaning of amount under clause 2.38.1........................ 236
2.38.2.................... Meaning of approved site............................................... 237
2.38.3.................... Application of Group T2................................................ 237
2.38.4.................... Application of items 15556, 15559 and 15562............... 237
Division 2.39--Group T3: Therapeutic nuclear medicine 250
2.39.1.................... Application of Group T3................................................ 250
Division 2.40--Group T4: Obstetrics 251
2.40.1.................... Definitions for item 16400.............................................. 251
2.40.2.................... Meaning of amount under clause 2.40.2........................ 251
2.40.3.................... Meaning of delivery........................................................ 252
2.40.4.................... Application of Group T4................................................ 252
2.40.5.................... Application of item 16400.............................................. 252
2.40.5A................. Limitation of item 16399................................................. 253
2.40.6.................... Limitation of items 16590 and 16591............................. 253
Division 2.41--Group T6: Examination by anaesthetist 260
2.41.1.................... Application of Group T6................................................ 260
2.41.2.................... Limitation of item 17609................................................. 260
Division 2.42--Group T7: Regional or field nerve blocks 264
2.42.1.................... Meaning of amount under clause 2.42.1........................ 264
2.42.2.................... Application of Group T7................................................ 264
Division 2.42A--Group T11: Botulinum toxin 268
2.42A.1................. Injection of botulinum toxin............................................ 268
2.42A.2................. Limitation of items 18360 and 18364............................. 268
Division 2.43--Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide) 272
2.43.1.................... Meaning of amount under clause 2.43.1........................ 272
2.43.2.................... Meaning of amount under clause 2.43.2........................ 273
2.43.3.................... Meaning of complex paediatric case.............................. 273
2.43.4.................... Meaning of service time.................................................. 273
2.43.5.................... Application of Group T10.............................................. 274
2.43.6.................... Application of Subgroup 21 of Group T10.................... 274
2.43.7.................... Services mentioned in Subgroups 21 to 25 of Group T10 275
2.43.8.................... Application of Subgroups 22 and 23 of Group T10....... 275
2.43.9.................... Application of Subgroups 24 and 25 of Group T10....... 275
Division 2.44--Group T8: Surgical operations 316
Subdivision A--General 316
2.44.1.................... Meaning of approved site............................................... 316
2.44.2.................... Application of Group T8................................................ 316
Subdivision B--Subgroup 1 of Group T8 316
2.44.4.................... Meaning of amount under clause 2.44.4........................ 316
2.44.5.................... Meaning of amount under clause 2.44.5........................ 316
2.44.6.................... Meaning of qualified surgeon......................................... 317
2.44.7.................... Meaning of qualified radiologist.................................... 317
2.44.8.................... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures...................................................................... 317
2.44.9.................... Application of items 30299 and 30300........................... 317
2.44.10.................. Application of items 30440, 30451, 30492 and 30495... 318
2.44.11.................. Application of items 30688, 30690, 30692 and 30694... 318
2.44.12.................. Application of item 35412.............................................. 318
2.44.12A............... Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590 318
Subdivision C--Subgroups 2 and 3 of Group T8 371
2.44.13.................. Meaning of foreign body in items 35360 to 35363......... 371
2.44.14.................. Application of items 32500 to 32517 and 35321............ 371
2.44.15.................. Application of items 35404, 35406 and 35408............... 371
2.44.15A............... Sacral nerve stimulation.................................................. 371
2.44.15B................ Artificial bowel sphincter................................................ 372
Subdivision D--Subgroups 4, 5 and 6 of Group T8 398
2.44.16.................. Application of items 38365, 38368 and 38654............... 398
2.44.17.................. Application of items 38470 to 38766.............................. 399
Subdivision E--Subgroups 7 to 11 of Group T8 444
Subdivision F--Subgroups 12 and 13 482
2.44.18.................. Meaning of amount under clause 2.44.18...................... 482
2.44.19.................. Meaning of maxilla......................................................... 483
Subdivision G--Subgroup 14 509
2.44.20.................. Items 46300 to 46534 apply only in certain circumstances 509
Subdivision H--Subgroup 15 516
2.44.21.................. Limitation of item 50303................................................. 516
Division 2.45--Group T9: Assistance at operations 563
2.45.1.................... Meaning of amount under clause 2.45.1........................ 563
2.45.2.................... Meaning of amount under clause 2.45.2........................ 563
2.45.3.................... Meaning of amount under clause 2.45.3........................ 563
2.45.4.................... Meaning of previous significant surgical complication.. 563
2.45.5.................... Application of Group T9................................................ 564
2.45.6.................... Assistance at operations.................................................. 564
Division 2.46--Oral and Maxillofacial services 566
2.46.1.................... Application of Groups O1 to O11.................................. 566
Division 2.47--Group O1: Consultations 567
Division 2.48--Group O2: Assistance at operation 568
2.48.1.................... Meaning of amount under clause 2.48.1........................ 568
2.48.2.................... Assistance at operations.................................................. 568
Division 2.49--Group O3: General surgery 569
Division 2.50--Group O4: Plastic and reconstructive 576
2.50.1.................... Meaning of maxilla......................................................... 576
Division 2.51--Group O5: Preprosthetic 581
Division 2.52--Group O6: Neurosurgical 582
Division 2.53--Group O7: Ear, nose and throat 583
Division 2.54--Group O8: Temporomandibular joint 585
Division 2.55--Group O9: Treatment of fractures 587
Division 2.56--Group O10: Diagnostic procedures and investigations 589
Division 2.57--Group O11: Regional or field nerve blocks 590
Part 3--Dictionary 591
Endnotes 604
Endnote 1--About the endnotes 604
Endnote 2--Abbreviation key 606
Endnote 3--Legislation history 607
Endnote 4--Amendment history 608
Endnote 5--Uncommenced amendments [none] 609
Endnote 6--Modifications [none] 609
Endnote 7--Misdescribed amendments [none] 609
Endnote 8--Miscellaneous [none] 609
The endnotes provide details of the history of this legislation and its provisions. The following endnotes are included in each compilation:
Endnote 1--About the endnotes
Endnote 2--Abbreviation key
Endnote 3--Legislation history
Endnote 4--Amendment history
Endnote 5--Uncommenced amendments
Endnote 6--Modifications
Endnote 7--Misdescribed amendments
Endnote 8--Miscellaneous
If there is no information under a particular endnote, the word "none" will appear in square brackets after the endnote heading.
Abbreviation key--Endnote 2
The abbreviation key in this endnote sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history--Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended the compiled law. The information includes commencement information for amending laws and details of application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision level. It also includes information about any provisions that have expired or otherwise ceased to have effect in accordance with a provision of the compiled law.
Uncommenced amendments--Endnote 5
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in endnote 5.
Modifications--Endnote 6
If the compiled law is affected by a modification that is in force, details of the modification are included in endnote 6.
Misdescribed amendments--Endnote 7
An amendment is a misdescribed amendment if the effect of the amendment cannot be incorporated into the text of the compilation. Any misdescribed amendment is included in endnote 7.
Miscellaneous--Endnote 8
Endnote 8 includes any additional information that may be helpful for a reader of the compilation.
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ad = added or inserted |
pres = present |
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am = amended |
prev = previous |
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c = clause(s) |
(prev) = previously |
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Ch = Chapter(s) |
Pt = Part(s) |
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def = definition(s) |
r = regulation(s)/rule(s) |
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Dict = Dictionary |
Reg = Regulation/Regulations |
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disallowed = disallowed by Parliament |
reloc = relocated |
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Div = Division(s) |
renum = renumbered |
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exp = expired or ceased to have effect |
rep = repealed |
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hdg = heading(s) |
rs = repealed and substituted |
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LI = Legislative Instrument |
s = section(s) |
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Sch = Schedule(s) |
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mod = modified/modification |
Sdiv = Subdivision(s) |
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No = Number(s) |
SLI = Select Legislative Instrument |
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o = order(s) |
SR = Statutory Rules |
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Ord = Ordinance |
Sub-Ch = Sub-Chapter(s) |
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orig = original |
SubPt = Subpart(s) |
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par = paragraph(s)/subparagraph(s) |
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Endnote 3--Legislation history
|
Number and year |
FRLI registration |
Commencement |
Application, saving and transitional provisions |
|
248, 2013 |
26 Nov 2013 (see F2013L01980) |
27 Nov 2013 |
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250, 2013 |
26 Nov 2013 (see F2013L01982) |
Sch 2 (items 3-28): 1 Jan 2014 |
-- |
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10, 2014 |
27 Feb 2014 (see F2014L00202) |
1 Mar 2014 |
-- |
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28, 2014 |
17 Mar 2014 (see F2014L00280) |
Sch 1 (items 1, 2): 18 Mar 2014 |
-- |
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Provision affected |
How affected |
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s 2........................................ |
rep LIA s 48D |
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Sch 1 |
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||
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Sch 1.................................... |
am No 250, 2013; No 10 and 28, 2014 |
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Sch 2.................................... |
rep LIA s 48C |
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Endnote 5--Uncommenced amendments [none]
Endnote 6--Modifications [none]