{"id":"F2020L00511","name":"Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020","slug":"health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":100109,"registerId":"commonwealth-F2020L00511-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1. Name","sectionType":"section","heading":"1. Name","content":"#### 1. Name\n\n  This instrument is the Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020.","sortOrder":0},{"sectionNumber":"3. Authority","sectionType":"section","heading":"3. Authority","content":"#### 3. Authority\n\n  This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4. Definitions","sectionType":"section","heading":"4. Definitions","content":"#### 4. Definitions\n\n(1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nrelevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.\n\nrelevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.\n\nSchedule means a Schedule to this instrument.\n\nNote: The following terms are defined in subsection 3(1) of the Act:\n\n clinically relevant service;\n\n general medical services table;\n\n item;\n\n professional service.\n\n(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.","sortOrder":2},{"sectionNumber":"5. Treatment of relevant services","sectionType":"section","heading":"5. Treatment of relevant services","content":"#### 5. Treatment of relevant services\n\nFor subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, 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\ni. related to the service; and\n\nii. specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.","sortOrder":3},{"sectionNumber":"6. Application of provisions of the gene","sectionType":"section","heading":"6. Application of provisions of the general medical services table","content":"#### 6. Application of provisions of the general medical services table\n\n  (1) Clause 5.8.1 of the general medical services table shall have effect as if item 18365 of this Determination was specified in the clause.\n  (2) Clause 5.8.2 of the general medical services table shall have effect as if item 18365 of this Determination was specified in subclause 5.8.2(2) and 5.8.2(3).","sortOrder":4},{"sectionNumber":"7. Indexation","sectionType":"section","heading":"7. Indexation","content":"#### 7\\. Indexation\n\n  (1) At the start of 1 July 2025 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:\n  ![1.024 multiplied by the amount immediately before the indexation time](image.002.png)\n\n> Note: The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).\n\n  (2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.\n  (3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).","sortOrder":5}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow purpose: establishing Medicare coverage for specific botulinum toxin injections. It has not expanded beyond this specific pharmaceutical class or medical service type."},"complexity_factors":["Only 4 substantive sections (excluding name and authority)","Minimal defined terms (3 explicit definitions plus 4 referenced from parent Act)","Simple conditional structure: service must be 'clinically relevant' and provided 'in accordance with this instrument'","Single cross-reference mechanism (treating the service as if it were in the general medical services table)","Straightforward indexation formula with basic rounding rule","No nested exceptions or complex temporal provisions beyond the 2025 indexation date"],"plain_english_summary":"This creates a new Medicare item allowing rebates for medically necessary botulinum toxin injections (Botox, Dysport, Xeomin), establishes state-based fees and automatic periodic fee increases, and confirms these uses as medical (not cosmetic). It affects patients needing treatment, clinicians who administer and claim payment, and Medicare administrators who process the rebates."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expands the set of services treated under subsection 3C(1) by specifying Botox, Dysport and Xeomin injections as \"relevant services\" and by prescribing an MBS item (item 18365) with state-specific fees (see clause 5). It also applies clauses of the general medical services table to that item (clause 6) and sets a fixed indexation step for fees effective 1 July 2025 (clause 7), thereby changing which services attract Medicare treatment and how fees will be adjusted."},"complexity_factors":["Cross-reference to subsection 3C(1) of the Health Insurance Act 1973 for authority and to multiple external instruments (clause 3; clause 4 definitions).","Reliance on existing, external general medical services table provisions rather than reproducing rules (clause 6), requiring users to consult another instrument for full effect.","Creation of a new MBS item (item 18365) whose fee and application depend on the Schedule (clause 5), so the operative detail is split between sections and an external Schedule.","Indexation mechanic with a fixed multiplier effective on a specific future date (1 July 2025) and a precise rounding rule, introducing a numerical arithmetic step in implementation (clause 7).","Reference to state-by-state fees in the Schedule increases administrative detail and variance by jurisdiction (clause 5).","Incorporation-as-in-force language for Acts and regulations (clause 4(2)) means ongoing legal change elsewhere can affect operation of this instrument."],"plain_english_summary":"This instrument adds Botox, Dysport and Xeomin injections as \"relevant services\" under subsection 3C(1) of the Health Insurance Act and treats those injections as both medical and professional services for Medicare billing, creating MBS item 18365 with state-by-state fees set in the Schedule. It applies existing general medical services rules to that item and fixes an indexation step from 1 July 2025 (multiplier 1.024) with specified rounding. It affects clinicians who bill Medicare, patients claiming rebates, and Medicare administrators."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination","history":"/api/acts/health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination/history","analysis":"/api/acts/health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination/analysis","conflicts":"/api/acts/health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination/conflicts","importantCases":"/api/acts/health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination/important-cases","documents":"/api/acts/health-insurance-section-3c-general-medical-services-botox-dysport-or-xeomin-injection-determination/documents"}}