{"id":"F2018L01465","name":"Health Insurance (Section 3C General Medical Services – Vigilance Testing) Determination 2018","slug":"health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":98144,"registerId":"commonwealth-F2018L01465-current","compilationNumber":null,"startDate":"2026-04-02","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Contents","sectionType":"subdivision","heading":"Contents","content":"#### Contents\n\n1. Name 1\n\n2. Commencement 1\n\n3. Authority 1\n\n4. Definitions 1\n\n5. Treatment of relevant services 1\n\n6. Application of provisions of the general medical services table 2\n\nSchedule 1 – relevant services 3\n\nEndnotes\n\nEndnote 1—About the endnotes 9\n\nEndnote 2—Abbreviation key 10\n\nEndnote 3—Legislation history 11\n\nEndnote 4—Amendment history 12","sortOrder":0},{"sectionNumber":"1. Name","sectionType":"part","heading":"1. Name","content":"# 1. Name\n\nThis Determination is the Health Insurance (Section 3C General Medical Services – Vigilance Testing) Determination 2018.","sortOrder":1},{"sectionNumber":"3. Authority","sectionType":"part","heading":"3. Authority","content":"# 3. Authority\n\nThis Determination is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":2},{"sectionNumber":"4. Definitions","sectionType":"part","heading":"4. Definitions","content":"# 4. Definitions\n\n(1) In this Determination:\n\nAct means the Health Insurance Act 1973.\n\nPharmaceutical Benefits Scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.\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 Determination.\n\nNote: The following terms are defined in subsection 3(1) of the Act:\n\n- clinically relevant service\n- general medical services table\n- item\n- professional service\n\n(2) Unless the contrary intention appears, a reference in this Determination 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":3},{"sectionNumber":"5. Treatment of relevant services","sectionType":"part","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 Determination 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\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 Schedule in relation to the service.","sortOrder":4},{"sectionNumber":"6. Application of provisions of the gene","sectionType":"part","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 1.2.10 of the general medical services table shall have effect as if item 12254, 12258, 12261, 12265, 12268 and 12272 were also specified in the clause.\n\n(2) Clause 2.36.2 of the general medical services table shall have effect as if item 12261 and 12265 were also specified in subclause 2.36.2(1).\n\n(3) Clause 2.36.2 of the general medical services table shall have effect as if item 12268 and 12272 were also specified in subclause 2.36.2(2).\n\n(4) Clause 2.36.2 of the general medical services table shall have effect as if item 12254 and 12258 were also specified in subclause 2.36.2(3).","sortOrder":5},{"sectionNumber":"Schedule 1","sectionType":"part","heading":"relevant services","content":"# \nSchedule 1 – relevant services\n\n```html\n

Category 2 – Diagnostic Procedures and Investigations

Group D1 – Miscellaneous Diagnostic Procedures And Investigations

Subgroup 10 – Other Diagnostic Procedures and Investigations

Item

Service

Fee ($)

12254

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged 18 years or more, if:

(a) a qualified sleep medicine practitioner or neurologist determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria for drugs relevant to treat that condition under the Pharmaceutical Benefits Scheme are fulfilled; and

(b) an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration is performed, with continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c) immediately following the overnight investigation a daytime investigation is performed where at least 4 nap periods are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

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

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

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

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12203, 12204, 12205, 12208, 12250 or 12258 is provided to the patient

Applicable only once in a 12 month period

928.30

12258

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged 18 years or more, if:

(a) a qualified sleep medicine practitioner or neurologist determines that testing is necessary to objectively confirm the ability to maintain wakefulness; and

(b) an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration is performed, with continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c) immediately following the overnight investigation, a daytime investigation is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

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

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

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

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12203, 12204, 12205, 12208, 12250 or 12254 is provided to the patient

Applicable only once in a 12 month period

928.30

12261

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged at least 12 years but less than 18 years, if:

(a) a qualified sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria for drugs relevant to treat that condition under the Pharmaceutical Benefits Scheme are fulfilled; and

(b) an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight investigation, a daytime investigation is performed where at least 4 nap periods are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

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

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

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12213, 12217 or 12265 is provided to the patient

Applicable only once in a 12 month period

973.35

12265

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged at least 12 years but less than 18 years, if:

(a) a qualified sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b) an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight investigation, a daytime investigation is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

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

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

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

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12213, 12217 or 12261 or is provided to the patient

Applicable only once in a 12 month period

973.35

12268

Multiple sleep latency test for the assessment of unexplained hypersomnolence for a patient less than 12 years of age, if:

(a) a qualified sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria for drugs relevant to treat that condition under the Pharmaceutical Benefits Scheme are fulfilled; and

(b) an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight investigation, a daytime investigation is performed where at least 4 nap periods are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

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

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

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

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12210, 12215 or 12272 is provided to the patient

Applicable only once in a 12 month period

1,044.00

12272

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness for a patient less than 12 years of age, if:

(a) a qualified sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b) an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight investigation, a daytime investigation is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

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

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

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

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12210, 12215 or 12268 is provided to the patient

Applicable only once in a 12 month period

1,044.00

\n```","sortOrder":6}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":3172},"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The determination maintains its original narrow scope. It exclusively specifies vigilance testing services (Multiple Sleep Latency Tests and Maintenance of Wakefulness Tests) for inclusion in Medicare benefits, matching the specific purpose indicated in its title and authorising provision (section 3C of the Health Insurance Act 1973)."},"complexity_factors":["Extensive cross-referencing to primary legislation (Health Insurance Act 1973, National Health Act 1953) and incorporated documents (general medical services table)","Technical medical specifications requiring continuous monitoring of nine distinct physiological parameters (airflow, EMG, ECG, EEG, EOG, oxygen saturation, respiratory movement, position, carbon dioxide)","Multi-layered conditional requirements for each service item (7-8 nested conditions per item including exclusion clauses)","Age-stratified service definitions with distinct procedural requirements for three separate age brackets (adults 18+, adolescents 12-18, children <12)","Dynamic legislative incorporation referencing provisions 'as in force from time to time'","Complex exclusion rules preventing concurrent billing with specific related item numbers"],"plain_english_summary":"This determination adds vigilance testing (daytime sleepiness and wakefulness assessments used to diagnose hypersomnolence/narcolepsy and confirm fitness for safety‑critical work) to the Medicare Benefits Schedule, making them rebated professional services.\n\nIt affects patients needing these tests, sleep medicine clinicians and technicians, and reduces out‑of‑pocket costs for otherwise expensive, specialist‑run, monitored sleep studies that are important for diagnosis and workplace safety."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018","history":"/api/acts/health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018/history","analysis":"/api/acts/health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018/analysis","conflicts":"/api/acts/health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018/conflicts","importantCases":"/api/acts/health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018/important-cases","documents":"/api/acts/health-insurance-section-3c-general-medical-services-vigilance-testing-determination-2018/documents"}}