{"id":"F2010L02692","name":"Health Insurance (Allied Health Services) Determination 2010","slug":"health-insurance-allied-health-services-determination-2010","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":437520,"registerId":"F2010L02692-fast-fetch-1775954320409","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name of Determination [see Note 1]","content":"1 Name of Determination [see Note 1]\n\n This Determination is the Health Insurance (Allied Health Services) Determination 2010.\n\n","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"2 Commencement\n\n This Determination commences on 1 November 2010.\n\n","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Revocation","content":"3 Revocation\n\n The Health Insurance (Allied Health Services) Determination 2009 (No.2) is revoked.\n\n","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Interpretation","content":"4 Interpretation\n\n (1) In this Determination:\n\nAct means the Health Insurance Act 1973.\n\nallied health professional, for the provision of an allied health service, means a person:\n\n (a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and\n\n (b) whose name is entered in the register, kept by the Medicare Australia CEO, of allied health professionals who are qualified to provide a service of that kind.\n\nallied health service means a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975 that is specified in an item in Schedule 2.\n\ncourse of treatment means:\n\n (a) for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:\n\n (i) an eligible clinical psychologist;\n\n (ii) an eligible psychologist;\n\n (iii) an eligible occupational therapist;\n\n (iv) an eligible social worker; and\n\n (b) for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:\n\n (i) an eligible psychologist;\n\n (ii) an eligible speech pathologist;\n\n (iii) an eligible occupational therapist.\n\neligible Aboriginal health worker means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service.\n\neligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.\n\neligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.\n\neligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.\n\neligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.\n\neligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.\n\neligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.\n\neligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.\n\neligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.\n\neligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:\n\n (b) an occupational therapy health service.\n\neligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.\n\neligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.\n\neligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.\n\neligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:\n\n (b) a non‑directive pregnancy support counselling health service;\n\n (c) a psychology health service.\n\neligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:\n\n (b) a non‑directive pregnancy support counselling health service.\n\neligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.\n\nfocussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑ based psychological therapies:\n\n (a) psycho‑education;\n\n (b) cognitive‑behavioural therapy that involves cognitive or behavioural interventions;\n\n (c) relaxation strategies;\n\n (d) skills training;\n\n (e) interpersonal therapy;\n\n (f) narrative therapy (for Aboriginal and Torres Strait Islander people).\n\nGP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the General Medical Services Table applies.\n\nGP Mental Health Treatment Plan, for a patient, means a GP Mental Health Treatment Plan for the patient to which item 2710 of the General Medical Services Table applies.\n\nmultidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the General Medical Services Table applies.\n\nNational Law means:\n\n (a) for a State or Territory other than Western Australia - the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and\n\n (b) for Western Australia – the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.\n\nnon‑directive pregnancy support counselling has the meaning given in subsection (2).\n\nOccupational Therapy Australia means the national body of the Australian Association of Occupational Therapists.\n\nPDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the General Medical Services Table applies.\n\nPsychology Board of Australia means that body established under section 31 of the National Law.\n\nrelevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.\n\nTeam Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or item 732 of the General Medical Services Table applies.\n\nNote The following terms are defined in subsection 3 (1) of the Act:\n\n dental practitioner\n\n general medical services table\n\n medical practitioner\n\n Medicare Australia CEO\n\n professional service.\n\n (2) A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a woman by a health professional in which:\n\n (a) information and issues relating to pregnancy are discussed; but\n\n (b) the health professional does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.\n\n","sortOrder":3},{"sectionNumber":"5","sectionType":"section","heading":"Treatment of allied health services","content":"5 Treatment of allied health services\n\n An allied health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:\n\n (a) it were both a professional service and a medical service; and\n\n (b) there were an item in the general medical services table that:\n\n (i) related to the service; and\n\n (ii) specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.\n\nNote For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.\n\n","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Limitation on certain items","content":"6 Limitation on certain items\n\n (1) For any particular patient, an item mentioned in subsection (2) applies in a calendar year only if the service described in the item is:\n\n (a) one of the first 12 relevant services provided to the patient in the calendar year; or\n\n (b) if exceptional circumstances exist in relation to the patient — one of the first 18 relevant services provided to the patient in the calendar year.\n\n (2) The items are items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.\n\n (3) In this section:\n\nexceptional circumstances exist in relation to a patient if:\n\n (a) the patient has, in a calendar year, received at least 12 relevant services; and\n\n (b) the patient’s referring medical practitioner is satisfied that there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for a service described in an item mentioned in paragraph (a) of the definition of relevant service.\n\nrelevant service means a service:\n\n (a) to which any of items 2721 to 2727 of the General Medical Services Table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply; or\n\n (b) to which the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care Program applies.\n\n7 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services\n\n (1) This section applies to items 80000 to 80170 in Schedule 2.\n\n (2) The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 293 to 370 of the General Medical Services Table e apply.\n\n (3) The referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 133 of the General Medical Services Table apply.\n\n (4) The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the General Medical Services Table apply.\n\n","sortOrder":5},{"sectionNumber":"8","sectionType":"section","heading":"Referrals by psychiatrists and paediatricians for pervasive developmental disorder services","content":"8 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services\n\n (1) This section applies to items 82000 to 82025 in Schedule 2.\n\n (2) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the General Medical Services Table apply.\n\n (3) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the General Medical Services Table apply.\n\n (4) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the General Medical Services Table applies.\n\n (5) If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the General Medical Services Table apply.\n\n (6) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which item 135 of the General Medical Services Table applies.\n\n (7) If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the General Medical Services Table apply.\n\n","sortOrder":6},{"sectionNumber":"9","sectionType":"section","heading":"Effect of election to claim private health insurance for an allied health service","content":"9 Effect of election to claim private health insurance for an allied health service\n\n An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.\n\n","sortOrder":7},{"sectionNumber":"Sch 1","sectionType":"schedule","heading":"Qualification requirements for allied health professionals","content":"Schedule 1 Qualification requirements for allied health professionals\n\n(section 4)\n\n \n\n| 1 | Aboriginal and Torres Strait Islander health service
A person is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service if:
(a) for a person who provides an Aboriginal and Torres Strait Islander health service in a State or Territory other than the Northern Territory — the person has been awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework; or
(b) for a person who provides an Aboriginal and Torres Strait Islander health service in the Northern Territory — the person is registered under the Health Practitioners Act (NT). |\n| --- | --- |\n| 2 | Audiology health service
A person is an allied health professional in relation to the provision of an audiology health service if the person is:
(a) a Full Member of the Audiological Society of Australia and the holder of a Certificate of Clinical Practice issued by that Society; or
(b) an Ordinary Member — Audiologist, or a Fellow Audiologist, of the Australian College of Audiology. |\n| 3 | Chiropractic health service
A person is an allied health professional in relation to the provision of a chiropractic health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |\n| 4 | Diabetes education health service
A person is an allied health professional in relation to the provision of a diabetes education health service if the person is credentialled by the Australian Diabetes Educators Association as a ‘Credentialled Diabetes Educator’. |\n| 5 | Dietetics health service
A person is an allied health professional in relation to the provision of a dietetics health service if the person is accredited by the Dietitians Association of Australia as an ‘Accredited Practising Dietitian’. |\n| 6 | Exercise physiology health service
A person is an allied health professional in relation to the provision of an exercise physiology health service if the person is accredited by the Exercise and Sports Science Australia as an ‘Accredited Exercise Physiologist’. |\n| 7 | Focussed psychological strategies health service
A person is an allied health professional in relation to the provision of a focussed psychological strategies health service if the person meets one of the following requirements:
(a) the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;
(b) the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008;
(c) the person:
(i) is a Full‑time Member, or a Part‑time Member, Occupational Therapy Australia; and
(ii) is, for a person who provides a focussed psychological strategies health service in Queensland, Western Australia, South Australia or the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and
(iii) has a minimum of 2 years experience in mental health; and
(iv) has given an undertaking to Occupational Therapy Australia to observe the standards set out in the document published by Occupational Therapy Australia titled ‘Australian Competency Standards for Occupational Therapists in Mental Health’, as in force on 1 November 2006. |\n| 8 | Mental health service
A person is an allied health professional in relation to the provision of a mental health service if the person meets one of the following requirements:
(a) the person meets the requirements specified for an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service;
(b) the person is a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses;
(c) the person is:
(i) for a person who provides a mental health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of Occupational Therapy Australia; and
(ii) for a person who is an occupational therapist and provides a mental health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;
(d) the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; |\n| | (e) the person is:
(i) a Member of the Australian Association of Social Workers; and
(ii) certified by that Association as meeting the standards for mental health set out in the document published by that Association titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008. |\n| 9 | Non‑directive pregnancy support counselling health service
A person is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service if the person meets one of the following requirements:
(a) the person is certified by the Australian College of Mental Health Nurses:
(i) as a credentialled mental health nurse; and
(ii) as appropriately trained in non‑directive pregnancy counselling;
(b) the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided and is certified by the Australian Psychological Society as appropriately trained in non-directive pregnancy counselling;
(c) the person is:
(i) a member of the Australian Association of Social Workers (AASW); and
(ii) certified by AASW either as meeting the standards for mental health set out in the document published by that Association titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008 or as an accredited social worker; and
(iii) certified by AASW as appropriately trained in non‑directive pregnancy counselling.
For this health service, a person is appropriately trained in non‑directive pregnancy counselling if the person has undergone training based on the key criteria contained in the document published by the Department titled ‘Key criteria for non‑directive pregnancy counselling training provided to GPs and allied health professionals in relation to the Medicare non‑directive pregnancy support counselling items’, as in force on 1 November 2006. |\n| 10 | Occupational therapy health service
A person is an allied health professional in relation to the provision of an occupational therapy health service if the person is:
(a) for a person who provides an occupational therapy health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of Occupational Therapy Australia; and
(b) for a person who provides an occupational therapy health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |\n| 11 | Osteopathy health service
A person is an allied health professional in relation to the provision of an osteopathy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |\n| 12 | Physiotherapy health service
A person is an allied health professional in relation to the provision of a physiotherapy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |\n| 13 | Podiatry health service
A person is an allied health professional in relation to the provision of a podiatry health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |\n| 14 | Psychological therapy health service
A person is an allied health professional in relation to the provision of a psychological therapy health service if the person:
(a) is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and
(b) either:
(i) is a member of the College of Clinical Psychologists of the Australian Psychological Society (APS): or
(ii) has been assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements; or
(iii) is endorsed by the Psychology Board of Australia to practice in clinical psychology. |\n| 15 | Psychology health service
A person is an allied health professional in relation to the provision of a psychology health service if the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |\n| 16 | Speech pathology health service
A person is an allied health professional in relation to the provision of a speech pathology health service if the person is:
(a) for a person who provides a speech pathology health service in a State or Territory other than Queensland — a Practising Member of Speech Pathology Australia; and
(b) for a person who provides a speech pathology health service in Queensland — registered as a person who may provide that kind of service under the applicable law in force in Queensland. |\n\n","sortOrder":8},{"sectionNumber":"Sch 2","sectionType":"schedule","heading":"Allied health services","content":"Schedule 2 Allied health services\n\n(section 6)\n\n","sortOrder":9},{"sectionNumber":"Part 1","sectionType":"part","heading":"Services and fees — general","content":"Part 1 Services and fees — general\n\n| 10950 | Aboriginal and Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible Aboriginal health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible Aboriginal health worker 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90
|\n| 10951 | Diabetes education health service provided to a person by an eligible diabetes educator if:
(a) the service is provided to a person who has:
(i) a chronic condition; and | 59.90
|\n| | (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | |\n| | (c) the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible diabetes educator 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10952 | Audiology health service provided to a person by an eligible audiologist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and (c) the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and | 59.90
|\n| | (e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and | |\n| | (g) after the service, the eligible audiologist 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 | |\n| | (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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10953 | Exercise physiology health service provided to a person by an eligible exercise physiologist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible exercise physiologist 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90
|\n| 10954 | Dietetics health service provided to a person by an eligible dietitian if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | 59.90
|\n| | (c) the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible dietitian 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10956 | Mental health service provided to a person by an eligible mental health worker if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | 59.90
|\n| | (c) the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and | |\n| | (g) after the service, the eligible mental health worker 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10958 | Occupational therapy health service provided to a person by an eligible occupational therapist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible occupational therapist 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 | 59.90
|\n| | (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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10960 | Physiotherapy health service provided to a person by an eligible physiotherapist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible physiotherapist 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90
|\n| 10962 | Podiatry health service provided to a person by an eligible podiatrist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and | 59.90
|\n| | (b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and | |\n| | (g) after the service, the eligible podiatrist 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10964 | Chiropractic health service provided to a person by an eligible chiropractor if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible chiropractor 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 | 59.90
|\n| | (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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10966 | Osteopathy health service provided to a person by an eligible osteopath if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible osteopath 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90
|\n| 10968 | Psychology health service provided to a person by an eligible psychologist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and | 59.90
|\n| | (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible psychologist 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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 10970 | Speech pathology health service provided to a person by an eligible speech pathologist if:
(a) the service is provided to a person who has:
(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and | 59.90
|\n| | (e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible speech pathologist 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 | |\n| | (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 or any other item in Part 1 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n\n","sortOrder":10},{"sectionNumber":"Part 2","sectionType":"part","heading":"Services and fees — psychological therapy and focussed psychological strategies","content":"Part 2 Services and fees — psychological therapy and focussed psychological strategies\n\n| 80000 | Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and
(c) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and
(d) the service is at least 30 minutes but less than 50 minutes duration
This item is subject to sections 7, 8 and 9 | 96.00 |\n| 80005 | Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80000
This item is subject to sections 6, 7 and 9 | 119.95
|\n| 80010 | Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 140.90 |\n| | (c) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and
(d) the service is at least 50 minutes duration
This item is subject to sections 6, 7 and 9 | |\n| 80015 | Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80010
This item is subject to sections 6, 7 and 9 | 164.85 |\n| 80020 | Psychological therapy health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided in person; and
(b) the service is at least 60 minutes duration;
to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year
This item is subject to sections 7 and 9 | 35.80 |\n| 80100 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 68.00 |\n| | (c) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and | |\n| | (d) the service is at least 20 minutes but less than 50 minutes duration
This item is subject to sections 6, 7 and 9 | |\n| 80105 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80100
This item is subject to sections 6, 7 and 9 | 92.50 |\n| 80110 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and
(c) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and
(d) the service is at least 50 minutes duration
This item is subject to sections 6, 7 and 9 | 96.00 |\n| 80115 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80110
This item is subject to sections 6, 7 and 9 | 120.55 |\n| 80120 | Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible psychologist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided in person; and | 24.50 |\n| | (b) the service is at least 60 minutes duration;
to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year
This item is subject to sections 7 and 9 | |\n| 80125 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and
(c) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and
(d) the service is at least 20 minutes but less than 50 minutes duration
This item is subject to sections 6, 7 and 9 | 59.90 |\n| 80130 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item 80125
This item is subject to sections 6, 7 and 9 | 84.35 |\n| 80135 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 84.60 |\n| | (c) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and
(d) the service is at least 50 minutes duration
This item is subject to sections 6, 7 and 9 | |\n| 80140 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item 80135
This item is subject to sections 6, 7 and 9 | 109.05 |\n| 80145 | Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible occupational therapist if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided in person; and
(b) the service is at least 60 minutes duration;
to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year
This item is subject to sections 7 and 9 | 21.50 |\n| 80150 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 59.90 |\n| | (c) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and | |\n| | (d) the service is at least 20 minutes but less than 50 minutes duration
This item is subject to sections 6, 7 and 9 | |\n| 80155 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80150
This item is subject to sections 6, 7 and 9 | 84.35 |\n| 80160 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and
(aa) the service is provided to the person individually and in person; and
(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and
(c) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and
(d) the service is at least 50 minutes duration
This item is subject to sections 6, 7 and 9 | 84.60 |\n| 80165 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80160
This item is subject to sections 6, 7 and 9 | 109.05 |\n| 80170 | Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible social worker if:
(a) the person is referred by:
(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or
(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or
(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and | 21.50 |\n| | (aa) the service is provided in person; and | |\n| | (b) the service is at least 60 minutes duration;
to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year
This item is subject to sections 7 and 9 | |\n\n","sortOrder":11},{"sectionNumber":"Part 3","sectionType":"part","heading":"Services and fees — pregnancy support counselling","content":"Part 3 Services and fees — pregnancy support counselling\n\n| 81000 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible psychologist if:
(a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and
(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and
(ba) the service is provided to the woman individually and in person; and
(c) the eligible psychologist does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and
(d) the service is at least 30 minutes duration;
to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy
The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate
This item is subject to section 9
[* in the General Medical Services Table] | 70.40 |\n| 81005 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible social worker if:
(a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and
(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and
(ba) the service is provided to the woman individually and in person; and
(c) the eligible social worker does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and
(d) the service is at least 30 minutes duration;
to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy
The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate
This item is subject to section 9
[* in the General Medical Services Table] | 70.40 |\n| 81010 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible mental health nurse if:
(a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and
(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and
(ba) the service is provided to the woman individually and in person; and
(c) the eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and
(d) the service is at least 30 minutes duration;
to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy
The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate
This item is subject to section 9
[* in the General Medical Services Table] | 70.40 |\n\n","sortOrder":12},{"sectionNumber":"Part 4","sectionType":"part","heading":"Services and fees — group services","content":"Part 4 Services and fees — group services\n\n","sortOrder":13},{"sectionNumber":"Div 4","sectionType":"division","heading":"1 Diabetes education services","content":"Division 4.1 Diabetes education services\n\n \n\n| 81100 | Diabetes education health service provided to a person by an eligible diabetes educator for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:
(a) the person has type 2 diabetes; and
(b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(c) the person is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 45 minutes duration; and
(g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c);
payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)
This item is subject to section 9 | 76.80 |\n| 81105 | Diabetes education health service provided to a person by an eligible diabetes educator, 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 item 81100, 81110 or 81120; and
(b) the service is provided to a person who is part of a group of between 2 and 12 patients; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided in person; and
(e) the service is of at least 60 minutes duration; and | 19.15 |\n| | (f) after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner; and | |\n| | (g) an attendance record for the group is maintained by the eligible diabetes educator;
to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)
This item is subject to section 9 | |\n\nDivision 4.2 Exercise physiology services\n\n \n\n| 81110 | Exercise physiology health service provided to a person by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:
(a) the person has type 2 diabetes; and
(b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(c) the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 45 minutes duration; and
(g) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c);
payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)
This item is subject to section 9 | 76.80 |\n| 81115 | Exercise physiology health service provided to a person by an eligible exercise physiologist, 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 item 81100, 81110 or 81120; and
(b) the service is provided to a person who is part of a group of between 2 and 12 patients; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided in person; and | 19.15 |\n| | (e) the service is of at least 60 minutes duration; and
(f) after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contributes to, a written report to be provided to the referring medical practitioner; and
(g) an attendance record for the group is maintained by the eligible exercise physiologist;
to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)
This item is subject to section 9 | |\n\nDivision 4.3 Dietetics services\n\n \n\n| 81120 | Dietetics health service provided to a person by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:
(a) the person has type 2 diabetes; and
(b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
(c) the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and | 76.80 |\n| | (f) the service is of at least 45 minutes duration; and
(g) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);
payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)
This item is subject to section 9 | |\n| 81125 | Dietetics health service provided to a person by an eligible dietitian, 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 item 81100, 81110 or 81120; and
(b) the service is provided to a person who is part of a group of between 2 and 12 patients; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided in person; and | 19.15 |\n| | (e) the service is of at least 60 minutes duration; and
(f) after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and
(g) 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 items 81105, 81115 and 81125 apply)
This item is subject to section 9 | |\n\n","sortOrder":14},{"sectionNumber":"Part 5","sectionType":"part","heading":"Services and fees — pervasive developmental disorder","content":"Part 5 Services and fees — pervasive developmental disorder\n\n| 82000 | Psychology health service provided to a child aged under 13 years by an eligible psychologist if:
(a) the child was referred to the eligible psychologist by an eligible practitioner:
(i) to assist with the diagnosis of the child by the practitioner; or
(ii) to contribute to the child’s PDD treatment and management plan; and
(b) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
(c) the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and
(d) the child is not an admitted patient of a hospital; and
(e) the service is provided to the child individually and in person; and
(f) the service is at least 50 minutes duration;
to a maximum of 4 services (including services to which this item or items 82005 and 82010 apply)
This item is subject to sections 8 and 9 | 96.00 |\n| 82005 | Speech pathology health service provided to a child aged under 13 years by an eligible speech pathologist if:
(a) the child was referred to the eligible speech pathologist by an eligible practitioner:
(i) to assist with the diagnosis of the child by the practitioner: or
(ii) to contribute to the child’s PDD treatment and management plan; and
(b) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
(c) the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and
(d) the child is not an admitted patient of a hospital; and
(e) the service is provided to the child individually and in person; and
(f) the service is at least 50 minutes duration;
to a maximum of 4 services (including services to which this item or items 82000 and 82010 apply)
This item is subject to sections 8 and 9 | 84.60 |\n| 82010 | Occupational therapy health service provided to a child aged under 13 years by an eligible occupational therapist if:
(a) the child was referred to the eligible occupational therapist by an eligible practitioner:
(i) to assist with the diagnosis of the child by the practitioner: or
(ii) to contribute to the child’s PDD treatment and management plan; and
(b) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
(c) the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and
(d) the child is not an admitted patient of a hospital; and
(e) the service is provided to the child individually and in person; and
(f) the service is at least 50 minutes duration;
to a maximum of 4 services (including services to which this item or items 82000 and 82005 apply)
This item is subject to sections 8 and 9 | 84.60 |\n| 82015 | Psychology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible psychologist, if:
(a) the child has been diagnosed with a PDD; and
(b) the child, while aged under 13 years, received a PDD treatment and management plan; and
(c) the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and
(d) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
(e) the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and
(f) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and
(g) the child is not an admitted patient of a hospital; and
(h) the service is provided to the child individually and in person; and
(i) the service is at least 30 minutes duration;
to a maximum of 20 services (including services to which this item or items 82020 and 82025 apply)
This item is subject to sections 8 and 9 | 96.00 |\n| 82020 | Speech pathology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible speech pathologist, if:
(a) the child has been diagnosed with a PDD; and | 84.60 |\n| | (b) the child, while aged under 13 years, received a PDD treatment and management plan; and
(c) the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and
(d) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and | |\n| | (e) the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and
(f) on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and
(g) the child is not an admitted patient of a hospital; and
(h) the service is provided to the child individually and in person; and
(i) the service is at least 30 minutes duration;
to a maximum of 20 services (including services to which this item or items 82015 and 82025 apply)
This item is subject to sections 8 and 9 | |\n| 82025 | Occupational therapy health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible occupational therapist if:
(a) the child has been diagnosed with a PDD; and
(b) the child, while aged under 13 years, received a PDD treatment and management plan; and
(c) the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and
(d) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
(e) the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and
(f) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and | 84.60 |\n| | (g) the child is not an admitted patient of a hospital; and
(h) the service is provided to the child individually and in person; and
(i) the service is at least 30 minutes duration;
to a maximum of 20 services (including services to which this item or items 82015 and 82020 apply)
This item is subject to sections 8 and 9 | |\n\n","sortOrder":15},{"sectionNumber":"Part 6","sectionType":"part","heading":"Services and fees — Aboriginal and Torres Strait Islander services","content":"Part 6 Services and fees — Aboriginal and Torres Strait Islander services\n\n| 81300 | Aboriginal and Torres Strait Islander health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible Aboriginal health worker if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible Aboriginal health worker by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible Aboriginal health worker 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81305 | Diabetes education health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible diabetes educator if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible diabetes educator by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and | 59.90 |\n| | (f) after the service, the eligible diabetes educator 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 | |\n| | (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 or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 81310 | Audiology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible audiologist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible audiologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible audiologist 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81315 | Exercise physiology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible exercise physiologist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible exercise physiologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible exercise physiologist 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 | 59.90 |\n| | (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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 81320 | Dietetics health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible dietitian if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible dietitian by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible dietitian 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81325 | Mental health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible mental health worker if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible mental health worker by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and | 59.90 |\n| | (f) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (b): | |\n| | (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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 81330 | Occupational therapy health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible occupational therapist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible occupational therapist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and | 59.90 |\n| | (f) after the service, the eligible occupational therapist 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 81335 | Physiotherapy health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible physiotherapist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible physiotherapist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and | 59.90 |\n| | (c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible physiotherapist 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | |\n| 81340 | Podiatry health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible podiatrist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible podiatrist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible podiatrist 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81345 | Chiropractic health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible chiropractor if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible chiropractor by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible chiropractor 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81350 | Osteopathy health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible osteopath if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible osteopath by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible osteopath 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81355 | Psychology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible psychologist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible psychologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible psychologist 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n| 81360 | Speech pathology health service provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible speech pathologist if:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and
(b) the person is referred to the eligible speech pathologist by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible speech pathologist 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 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year
This item is subject to section 9 | 59.90 |\n\n \n\n","sortOrder":16},{"sectionNumber":"Sch 3","sectionType":"schedule","heading":"Transitional provisions","content":"Schedule 3 Transitional provisions\n\n1 Items in Schedule 2 have effect according to their terms.\n\n2 A person who was an allied health professional in relation to the provision of a podiatry health service provided in the Northern Territory immediately before the amendments made by Schedule 1 to the Health Insurance (Allied Health Services) Determination 2009 (No 2) is taken to be an allied health professional in relation to the provision of a podiatry health service in the Northern Territory until 31 December 2010.\n\n3 A person who was an allied health professional in relation to the provision of a mental health service provided in Tasmania or the Australian Capital Territory immediately before the amendments made by Schedule 1 to the Health Insurance (Allied Health Services) Determination 2009 (No 2) is taken to be an allied health professional in relation to the provision of a mental health service in Tasmania or the Australian Capital Territory until 31 December 2010.\n\n \n\n \n\n \n","sortOrder":17}],"analysis":{"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":true,"description":"The Determination replaces the 2009 instrument (section 3) and re‑specifies the set of Medicare‑recognised allied health items, provider credentials, fees, referral/reporting requirements and annual limits. Transitional provisions preserve certain prior practitioner arrangements until specified dates (Schedule 3). The text therefore updates the scope of covered services and administrative rules compared with the revoked Determination (section 3; Schedule 3)."},"complexity_factors":["Detailed, profession‑specific qualification matrix across jurisdictions (section 4; Schedule 1)","Large schedule of discrete itemised services with different fees, durations and group/individual rules (Schedule 2 Parts 1–6)","Multiple cross‑references to the Health Insurance Act, General Medical Services Table and the National Law (sections 4, 5, 7, 8)","Referral and credentialing rules that vary by referrer type (GP, consultant psychiatrist, paediatrician, specialist) and by item (sections 4, 7, 8; Schedule 2)","Per‑patient annual caps and an ‘exceptional circumstances’ carve‑out with procedural requirements (section 6)","Requirement to be entered on a Medicare Australia register and give written reports to referring practitioners (section 4; Schedule 2 items)","State/territory differences for registration and membership criteria embedded in qualification rules (Schedule 1)","Interaction with private health insurance (section 9) — creates exclusion that affects patient payment paths","Transitional provisions and a wholesale revocation of the prior Determination (section 3; Schedule 3), requiring administrative adjustments","Numerous conditional requirements (referral form contents, GP Management/Team Care Plans, minimum durations) that increase compliance burden (Schedule 2; section 4 definitions)"],"plain_english_summary":"This Determination lists specific allied‑health services that Medicare will recognise as both professional and medical services, sets the eligible provider qualifications and Medicare‑registration requirement, prescribes referral, reporting and session‑length rules, and fixes fees for each service. It also imposes per‑patient annual limits on certain mental‑health items and prevents claiming a private health insurance benefit for the same service.\n\nIt principally affects allied‑health practitioners, referring medical practitioners, patients receiving allied care, Medicare administration and private insurers because it determines who may be paid, how much, when services are allowed, and what paperwork must be kept."},"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":3973},"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"This Determination consolidates and replaces the 2009 (No. 2) version, maintaining the established scope of listing Medicare-eligible allied health services. It continues the existing statutory framework covering chronic disease management, mental health services, pregnancy counselling, diabetes group services, and pervasive developmental disorder services without significant expansion beyond the operational parameters authorised by the Health Insurance Act 1973."},"complexity_factors":["25+ defined terms in section 4, including nested definitions where 'eligible [profession]' references back to the base definition of 'allied health professional'","Extensive cross-referencing to the General Medical Services Table for referral pathways (e.g., items 721, 732, 2710, 289) and plan types","State and territory variations in qualification requirements (e.g., Northern Territory Aboriginal health workers, Queensland speech pathologists, Western Australia National Law application)","Multiple overlapping service caps: general 12-service annual limit with 18-service 'exceptional circumstances' override, plus specific 5-service caps for chronic disease, 3-service caps for pregnancy counselling, 20-service caps for pervasive developmental disorder treatment, and 8-service caps for diabetes group services","Item-specific conditional logic with up to 7 sub-paragraphs of prerequisites per service (referral type, patient location, duration, reporting requirements, hospital status, registration status)","Distinct referral pathways requiring specific GP plan types (GP Management Plan, Team Care Arrangements, GP Mental Health Treatment Plan, PDD treatment and management plan)","Exceptional circumstances definition requiring both quantitative threshold (12 services already provided) and qualitative clinical judgment (significant change in condition)"],"plain_english_summary":"This Determination sets the rules for Medicare rebates for allied health services — who can claim them, which allied‑health professionals qualify, and the core limits on visits and billing. It applies to patients with chronic conditions, mental‑health needs, pregnancy counselling, children with developmental disorders, and Aboriginal and Torres Strait Islander clients, and to the listed allied‑health providers.\n\nIt matters because it fixes referral, time, reporting and annual‑cap rules that determine access, eligibility and how services are billed."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-allied-health-services-determination-2010","history":"/api/acts/health-insurance-allied-health-services-determination-2010/history","analysis":"/api/acts/health-insurance-allied-health-services-determination-2010/analysis","conflicts":"/api/acts/health-insurance-allied-health-services-determination-2010/conflicts","importantCases":"/api/acts/health-insurance-allied-health-services-determination-2010/important-cases","documents":"/api/acts/health-insurance-allied-health-services-determination-2010/documents"}}