{"id":"health-services-fees-and-charges-order-2016","name":"Health Services (Fees and Charges) Order 2016","slug":"health-services-fees-and-charges-order-2016","collection":"regulation","jurisdiction":"wa","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":176795,"registerId":"wa-health-services-fees-and-charges-order-2016-current","compilationNumber":null,"startDate":"2026-04-05","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Services (Fees and Charges) Order 2016","content":"![Crest]()Western Australia\n\nHealth Services Act 2016\n\nHealth Services (Fees and Charges) Order 2016\n\nWestern Australia\n\nHealth Services (Fees and Charges) Order 2016\n\nContents\n\nPart 1 — Preliminary\n\n1. Citation 1\n\n2. Commencement 1\n\n3. Terms used 1\n\n3A. Classes of compensable patients 7\n\nPart 2 — Fees and charges\n\n4. Fees and charges 10\n\n5. General fees and charges 10\n\n6. Compensable patients 11\n\n6A. Medicare ineligible patients 11\n\n7. Magnetic resonance imaging services 11\n\n8. Pathology services 12\n\n9. Specialised orthoses 12\n\n10. Surgically implanted prostheses 13\n\n10A. Provision of medicines 13\n\nPart 3 — Classes of patients\n\n11. Classes of patients 15\n\n12. Classes of in‑patients 16\n\n13. Classes of day patients 19\n\n14. Classes of out‑patients 20\n\n15. Classes of same day patients 22\n\nSchedule 1 — Fees and charges\n\nDivision 1 — General\n\nSubdivision 1 — In‑patients\n\nSubdivision 2 — Day patients\n\nSubdivision 3 — Out‑patients\n\nSubdivision 4 — Same day patients\n\nSubdivision 5 — Other services\n\nDivision 2 — Compensable patients\n\nSubdivision 1 — Compensable in‑patients\n\nSubdivision 2 — Compensable out‑patients\n\nSubdivision 3 — Compensable same day patients\n\nDivision 3 — Magnetic resonance imaging\n\nDivision 4 — Pathology services\n\nDivision 6 — Surgically implanted prostheses\n\nNotes\n\nCompilation table 32\n\nDefined terms\n\n  \n\nHealth Services Act 2016\n\nHealth Services (Fees and Charges) Order 2016\n\n## Part 1 — Preliminary\n\n##### 1. Citation\n\n\t\tThis order is the *Health Services (Fees and Charges) Order 2016*.\n\n##### 2. Commencement\n\nThis order comes into operation on the day on which the *Health Services Act 2016* section 56 comes into operation.\n\n##### 3. Terms used\n\n(1) In this order, unless the contrary intention appears —\n\nasylum seeker means a person —\n\n(a) who has applied for —\n\n(i) a permanent protection visa within the meaning of the *Migration Act 1958* (Commonwealth) section 35A(2); or\n\n(ii) a temporary protection visa within the meaning of the *Migration Act 1958* (Commonwealth) section 35A(3); or\n\n(iii) a safe haven enterprise visa within the meaning of the *Migration Act 1958* (Commonwealth) section 35A(3A);\n\nand\n\n(b) whose visa application referred to in paragraph (a) has not yet been decided;\n\ncompensable day patient has the meaning given in clause 3A(1);\n\ncompensable in‑patient has the meaning given in clause 3A(2);\n\ncompensable out‑patient has the meaning given in clause 3A(3);\n\ncompensable patient means any of the following —\n\n(a) a compensable day patient;\n\n(b) a compensable in‑patient;\n\n(c) a compensable out‑patient;\n\n(d) a compensable same day patient;\n\ncompensable same day patient has the meaning given in clause 3A(4);\n\nconcessional beneficiary has the meaning given in clause 14(2)(e);\n\nday hospital means a hospital at which health services which require full‑time or part‑time non‑residential attendance at specific and regular intervals over a period of time are provided;\n\nday patient has the meaning given in clause 11(1)(b);\n\nDVA arrangement means a hospital services arrangement made from time to time between the State and the Commonwealth and others for health services provided to veterans;\n\neligible day patient has the meaning given in clause 13(2)(b);\n\neligible out‑patient has the meaning given in clause 14(2)(c);\n\neligible person has the meaning given in the *Health Insurance Act 1973* (Commonwealth) section 3 and —\n\n(a) includes a person who is required by or under that Act to be treated as an eligible person for the purposes of that Act; but\n\n(b) does not include a person who is required by or under that Act not to be treated as an eligible person for the purposes of that Act;\n\neligible veteran in‑patient has the meaning given in clause 12(2)(d);\n\neligible veteran out‑patient has the meaning given in clause 14(2)(b);\n\neligible veteran same day patient has the meaning given in clause 15(2)(d);\n\nentitlement card has the same meaning as it has in the National Health Act Part VII;\n\nGold Card means a currently valid health card, known by that name, issued by the Commonwealth Department of Veterans’ Affairs;\n\nhospital means a public hospital;\n\nhospital bed means —\n\n(a) a bed used for accommodation, maintenance and nursing care of a patient in a hospital that is not a nursing home; and\n\n(b) a bed designated under subclause (2);\n\nineligible day patient has the meaning given in clause 13(2)(c);\n\nineligible in‑patient has the meaning given in clause 12(2)(g);\n\nineligible out‑patient has the meaning given in clause 14(2)(d);\n\nineligible same day patient has the meaning given in clause 15(2)(e);\n\nin‑patient means a patient who is admitted to a hospital for the purpose of receiving health services in a hospital bed;\n\ninternal Territory has the meaning given in the *Acts Interpretation Act 1901* (Commonwealth) section 2B;\n\ninvoluntary patient has the meaning given in subclause (3);\n\nMedicare Benefits Schedule means the Medicare Benefits Schedule published by the Commonwealth, as that Schedule is in force from time to time;\n\nMedicare ineligible asylum seeker means a person who —\n\n(a) is an asylum seeker; and\n\n(b) is not an eligible person; and\n\n(c) is not a compensable patient;\n\nMedicare ineligible involuntary patient means a person who —\n\n(a) is an involuntary patient; and\n\n(b) is not an eligible person; and\n\n(c) is not a compensable patient;\n\nmidwife means a person registered under the *Health Practitioner Regulation National Law (Western Australia)* in the midwifery profession;\n\nmidwifery service means a midwifery service that is to be treated as both a professional service and a medical service in accordance with a determination made under the *Health Insurance Act 1973* (Commonwealth) section 3C(1);\n\nNational Health Act means the *National Health Act 1953* (Commonwealth);\n\nnursing home bed means a bed used for the accommodation, maintenance and nursing care of a patient at a nursing home, but does not include a hospital bed in a nursing home;\n\nnursing home type patient has the meaning given in clause 12(2)(e);\n\nnursing home type private patient has the meaning given in clause 12(2)(f);\n\nout‑patient has the meaning given in clause 11(1)(c);\n\nparticipating hospital means a public hospital in the State, if either or both of the following applies in relation to the hospital —\n\n(a) an approval under the National Health Act section 94 is in force in relation to the health service provider for the hospital;\n\n(b) the health service provider for the hospital is authorised to supply pharmaceutical benefits pursuant to a special arrangement in force under the National Health Act section 100;\n\nPBS list means the list of medicines set out in the document “Schedule of Pharmaceutical Benefits” published from time to time, for the purposes of the National Health Act, by the Department of State of the Commonwealth that is administered by the Commonwealth Minister administering that Act;\n\nPBS price means the price specified in the PBS list;\n\npensioner has the meaning given in clause 14(2)(f);\n\npensioner concession card means a currently valid card, known by that name, issued on behalf of the Commonwealth;\n\nprivate in‑patient has the meaning given in clause 12(2)(b);\n\nprivate pathology out‑patient means a person classified under clause 14(4)(a);\n\nprivate same day patient has the meaning given in clause 15(2)(b);\n\nprofessional service means a service referred to in paragraph (a), (b) or (ba) of the definition of ***professional service*** in the *Health Insurance Act 1973* (Commonwealth) section 3(1);\n\npublic in‑patient has the meaning given in clause 12(2)(a);\n\npublic same day patient has the meaning given in clause 15(2)(a);\n\nsame day patient has the meaning given in clause 11(1)(d);\n\nsurgically implanted prosthesis means a prosthesis listed in the Private Health Insurance (Prostheses) Rules as in force from time to time under the *Private Health Insurance Act 2007* (Commonwealth) section 333‑20;\n\nveteran means a person who has received or is entitled to receive health services under the *Veterans’ Entitlements Act 1986* (Commonwealth), the *Military Rehabilitation and Compensation Act 2004* (Commonwealth), the *Safety Rehabilitation and Compensation Act 1988* (Commonwealth) or the *Australian Participants in British Nuclear Tests (Treatment) Act 2006* (Commonwealth);\n\nWhite Card means a currently valid health card, known by that name, issued by the Commonwealth Department of Veterans’ Affairs.\n\n(2) A bed in a nursing home may be designated as a “hospital bed” by the Minister.\n\n(3) A person is an involuntary patient if —\n\n(a) the person is under an inpatient treatment order as defined in the *Mental Health Act 2014* section 4; or\n\n(b) the person is under a community treatment order as defined in the *Mental Health Act 2014* section 4; or\n\n(c) the person is under another order under the *Mental Health Act 2014* under which they are, or may be, detained; or\n\n(d) the person has been referred under the *Mental Health Act 2014* section 26(2) or (3)(a) and —\n\n(i) the referral has not expired; and\n\n(ii) the referral has not been revoked under the *Mental Health Act 2014* section 31; and\n\n(iii) the examination referred to in the *Mental Health Act 2014* section 26(1) has not been conducted;\n\nor\n\n(e) the person has been referred under the *Mental Health Act 2014* section 36(2) and —\n\n(i) the referral has not expired; and\n\n(ii) the referral has not been revoked under the *Mental Health Act 2014* section 37; and\n\n(iii) the examination referred to in the *Mental Health Act 2014* section 36(2) has not been conducted.\n\n[Clause 3 amended: Gazette 2 Feb 2018 p. 315; 13 Nov 2018 p. 4432; SL 2023/34 cl. 4; SL 2023/87 cl. 4.]\n\n##### 3A. Classes of compensable patients\n\n(1) A compensable day patient is a day patient —\n\n(a) who —\n\n(i) has received or established a right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services; or\n\n(ii) when attending a hospital appears prima facie to have the right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services;\n\nand\n\n(b) in relation to whom a decision under subclause (5) has not been made in relation to the patient and the health services the patient is receiving.\n\n(2) A compensable in‑patient is an in‑patient —\n\n(a) who —\n\n(i) has received or established a right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services; or\n\n(ii) when attending a hospital appears prima facie to have the right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services;\n\nand\n\n(b) in relation to whom a decision under subclause (5) has not been made in relation to the patient and the health services the patient is receiving.\n\n(3) A compensable out‑patient is an out‑patient —\n\n(a) who —\n\n(i) has received or established a right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services; or\n\n(ii) when attending a hospital appears prima facie to have the right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services;\n\nand\n\n(b) in relation to whom a decision under subclause (5) has not been made in relation to the patient and the health services the patient is receiving.\n\n(4) A compensable same day patient is a same day patient —\n\n(a) who is an eligible person and who —\n\n(i) has received or established a right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services; or\n\n(ii) when attending a hospital appears prima facie to have the right to receive compensation in respect of an injury, illness or disease for which the patient is receiving health services;\n\nand\n\n(b) in relation to whom a decision under subclause (5) has not been made in relation to the patient and the health services the patient is receiving.\n\n(5) The chief executive of the health service provider that is providing a health service to a compensable day patient, compensable in‑patient, compensable out‑patient or compensable same day patient may decide that the patient is not a compensable patient in relation to those services if the chief executive is satisfied that —\n\n(a) the compensation received in relation to the injury, illness or disease has been spent and the person is not entitled to further compensation in relation to the injury, illness or disease; or\n\n(b) the patient no longer has a right to compensation in relation to the injury, illness or disease for which it was received (including, for example, that a statutory limit to compensation has been reached); or\n\n(c) having regard to the circumstances of the patient, the patient would be unfairly disadvantaged by continuing to be a compensable patient; or\n\n(d) it is not in the interest of the health service provider for the patient to be a compensable patient in relation to the health service.\n\n[Clause 3A inserted: SL 2023/87 cl. 5.]\n\n## Part 2 — Fees and charges\n\n[Heading amended: SL 2020/5 cl. 4.]\n\n##### 4. Fees and charges\n\nThe fees and charges fixed under section 56 of the Act are set out in Schedule 1.\n\n[Clause 4 amended: SL 2023/87 cl. 6.]\n\n##### 5. General fees and charges\n\n(1) Except as provided in subclause (2), the fees and charges set out in Schedule 1 Division 1 apply in respect of —\n\n(a) the services referred to in Schedule 1 Division 1 that are provided by, in or at a hospital by a health service provider to the classes of patients referred to in Schedule 1 Division 1; and\n\n(b) any other services mentioned in Schedule 1 Division 1.\n\n(2) The fees and charges set out in Schedule 1 Division 1 do not apply in respect of —\n\n(a) a service to which a fee or charge set out in Schedule 1 Division 2, 3 or 4 applies; or\n\n(b) the supply of a specialised orthosis to which a charge under clause 9 applies; or\n\n(c) the supply of a surgically implanted prosthesis to which a fee or charge set out in Schedule 1 Division 6 applies; or\n\n(d) a service to which a charge under clause 10A applies.\n\n[Clause 5 amended: SL 2020/5 cl. 5; SL 2020/58 cl. 4.]\n\n##### 6. Compensable patients\n\n(1) Except as provided in subclause (2), the fees and charges set out in Schedule 1 Division 2 apply in respect of —\n\n(a) services provided by, in or at a hospital to compensable in‑patients and compensable out‑patients; and\n\n(b) services provided by, at or in a hospital to compensable same day patients (other than services rendered by, in or at a day hospital, nursing home or nursing post).\n\n(2) The fees and charges set out in Schedule 1 Division 2 do not apply in respect of —\n\n(a) a service to which a fee or charge set out in Schedule 1 Division 1, 3 or 4 applies; or\n\n(b) the supply of a specialised orthosis to which a charge under clause 9 applies; or\n\n(c) the supply of surgically implanted prostheses to which a fee or charge set out in Schedule 1 Division 6 applies.\n\n[Clause 6 amended: SL 2020/58 cl. 5; SL 2023/87 cl. 7.]\n\n##### 6A. Medicare ineligible patients\n\nDespite any other provision of this Part, no fees or charges are payable in respect of a health service provided to —\n\n(a) a Medicare ineligible asylum seeker; or\n\n(b) a Medicare ineligible involuntary patient as part of their treatment under the *Mental Health Act 2014*.\n\n[Clause 6A inserted: SL 2023/34 cl. 5.]\n\n##### 7. Magnetic resonance imaging services\n\n(1) In this clause —\n\nprovider hospital means a hospital that has magnetic resonance imaging equipment in respect of which a Medicare benefit is payable for magnetic resonance imaging services in accordance with regulations made under the *Health Insurance Act 1973* (Commonwealth) section 4AA(1).\n\n(2) The fees and charges set out in Schedule 1 Division 3 apply in respect of a magnetic resonance imaging service that is provided by, in or at a provider hospital to —\n\n(a) a compensable in‑patient; or\n\n(b) an ineligible in‑patient; or\n\n(c) a compensable out‑patient; or\n\n(d) an ineligible out‑patient; or\n\n(e) a compensable same day patient; or\n\n(f) an ineligible same day patient.\n\n[Clause 7 amended: Gazette 9 Mar 2018 p. 797.]\n\n##### 8. Pathology services\n\nThe fees and charges set out in Schedule 1 Division 4 apply in respect of pathology services specified in the Medicare Benefits Schedule that are provided to patients mentioned in that Division.\n\n##### 9. Specialised orthoses\n\n(1) In this clause —\n\nadult chargeable patient means a chargeable patient who has reached 18 years of age;\n\nchargeable patient means —\n\n(a) a private in‑patient; or\n\n(b) a compensable in‑patient; or\n\n(c) an ineligible in‑patient; or\n\n(d) a compensable out‑patient; or\n\n(e) an eligible out‑patient; or\n\n(f) an ineligible out‑patient; or\n\n(g) a private same day patient; or\n\n(h) a compensable same day patient; or\n\n(i) an ineligible same day patient;\n\nchild chargeable patient means a chargeable patient who is under 18 years of age.\n\n(2) The charge for the supply of a specialised orthosis to an adult chargeable patient or a child chargeable patient is to be of an amount determined by the Department CEO according to the cost of supplying the specialised orthosis.\n\n(3) The Department CEO must ensure that a determination made under subclause (2) is publicly available.\n\n[Clause 9 amended: Gazette 9 Mar 2018 p. 798; SL 2020/58 cl. 6.]\n\n##### 10. Surgically implanted prostheses\n\n(1) In this clause —\n\nprovider hospital means a hospital other than a day hospital, nursing home or nursing post.\n\n(2) The fees and charges set out in Schedule 1 Division 6 apply in respect of the supply in a provider hospital of a surgically implanted prosthesis set out in that Schedule to —\n\n(a) a private in‑patient; or\n\n(b) a compensable in‑patient; or\n\n(c) an ineligible in‑patient; or\n\n(d) a private same day patient; or\n\n(e) a compensable same day patient; or\n\n(f) an ineligible same day patient.\n\n##### 10A. Provision of medicines\n\n(1) The charge for the provision of a medicine in a hospital to a patient of any of the following classes is to be of an amount determined by the Department CEO according to the cost of providing the medicine —\n\n(a) ineligible in‑patient;\n\n(b) ineligible out‑patient;\n\n(c) ineligible day patient;\n\n(d) ineligible same day patient.\n\n(2) The Department CEO must ensure that a determination made under subclause (1) is publicly available.\n\n[Clause 10A inserted: SL 2020/5 cl. 6.]\n\n## Part 3 — Classes of patients\n\n##### 11. Classes of patients\n\n(1) Subject to subclause (2), for the purpose of a service provided in respect of a patient by, in or at a hospital, the patient must be classified as —\n\n(a) an in‑patient; or\n\n(b) a day patient, namely, a person who receives health services at a day hospital; or\n\n(c) an out‑patient, namely, a person —\n\n(i) who attends at a hospital and receives health services under an out‑patient service provided at the hospital; or\n\n(ii) in respect of whom a hospital provides a health service elsewhere than at the hospital;\n\nor\n\n(d) a same day patient, namely, a person who is admitted to and discharged from a hospital, not being a day hospital, nursing home or a nursing post, between midnight on one day and midnight on the next succeeding day for the purpose of receiving health services.\n\n(2) For the purpose of a service provided in respect of a patient by, in or at a hospital, the patient does not need to be classified under subclause (1) if the patient is —\n\n(a) a Medicare ineligible asylum seeker; or\n\n(b) a Medicare ineligible involuntary patient and the service is provided as part of their treatment under the *Mental Health Act 2014*.\n\n[Clause 11 amended: SL 2023/34 cl. 6.]\n\n##### 12. Classes of in‑patients\n\n(1) An in‑patient must be classified under this clause for the purpose of the payment of the fees and charges set out in Schedule 1 in respect of an in‑patient.\n\n(2) Subject to subclause (4), an in‑patient must be classified as —\n\n(a) a public in‑patient, namely, an in‑patient —\n\n(i) who is an eligible person (not being a compensable in‑patient, nursing home type patient or nursing home type private patient, or an in‑patient who elects to be treated as a private in‑patient); and\n\n(ii) who elects to be treated as a public in‑patient; and\n\n(iii) in respect of whom the hospital concerned provides, in a hospital bed, accommodation, maintenance, nursing care and appropriate professional services and such other necessary services as are available;\n\nor\n\n(b) a private in‑patient, namely, an in‑patient —\n\n(i) who is an eligible person (not being a compensable in‑patient, nursing home type patient or nursing home type private patient); and\n\n(ii) who elects to be treated as a private in‑patient; and\n\n(iii) in respect of whom the hospital concerned provides, in a hospital bed, accommodation, maintenance, nursing care and such other necessary services as are available, other than professional and dental services provided by a practitioner acting in a private capacity or midwifery services provided by a midwife acting in a private capacity;\n\nor\n\n(c) a compensable in‑patient; or\n\n(d) an eligible veteran in‑patient, namely, an in‑patient —\n\n(i) who is a veteran; and\n\n(ii) who elects to be treated under the DVA arrangement;\n\nor\n\n(e) a nursing home type patient, namely, an in‑patient (not being a compensable in‑patient or an ineligible patient) —\n\n(i) who is a nursing home type patient within the meaning of the *Health Insurance Act 1973* (Commonwealth); and\n\n(ii) in respect of whom the hospital concerned provides, in a hospital bed, accommodation and nursing care and appropriate professional services and such other necessary services as are available;\n\nor\n\n(f) a nursing home type private patient, namely, an eligible person (not being a compensable in‑patient) —\n\n(i) who is a nursing home type patient within the meaning of the *Health Insurance Act 1973* (Commonwealth); and\n\n(ii) who elects to be treated as a nursing home type private patient; and\n\n(iii) in respect of whom the hospital concerned provides, in a hospital bed, accommodation, nursing care and such other necessary services as are available, other than professional and dental services provided by a practitioner acting in a private capacity;\n\nor\n\n(g) an ineligible in‑patient, namely, an in‑patient —\n\n(i) who is not an eligible person (other than a person or a member of a class of persons to whom or to which a declaration made under the *Health Insurance Act 1973* (Commonwealth) section 6(2) applies in the relevant circumstances); and\n\n(ii) who is not a compensable in‑patient; and\n\n(iii) in respect of whom the hospital concerned provides, in a hospital bed, accommodation, nursing care and such other necessary services as are available, other than professional and dental services provided by a practitioner acting in a private capacity.\n\n(3) For the purposes of subclause (2)(c), a compensable in‑patient includes a person in respect of the payment for whose health services one or more of the following applies or appears prima facie to apply —\n\n(a) the *Workers Compensation and Injury Management Act 2023*;\n\n(ab) the *Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016*;\n\n(b) the *Motor Vehicle (Third Party Insurance) Act 1943*;\n\n(c) the law of Australia relating to the Defence Force within the meaning of the *Defence Act 1903* (Commonwealth).\n\n(4) At the time of admission to a hospital, or as soon as practicable after admission, an eligible person (not being a compensable in‑patient or a veteran) must elect whether that person wishes to be classified as —\n\n(a) a public in‑patient; or\n\n(b) a private in‑patient.\n\n(5) At the time of admission to a hospital, or as soon as practicable after admission, a veteran must elect whether the veteran wishes to be classified as —\n\n(a) an eligible veteran in‑patient; or\n\n(b) a public in‑patient; or\n\n(c) a private in‑patient.\n\n[Clause 12 amended: Gazette 9 Mar 2018 p. 798; SL 2023/87 cl. 8; SL 2024/81 cl. 4; SL 2024/104 cl. 4.]\n\n##### 13. Classes of day patients\n\n(1) A day patient must be classified under this clause for the purpose of the payment of the fees and charges set out in Schedule 1 in respect of a day patient.\n\n(2) A day patient must be classified as —\n\n(a) a compensable day patient; or\n\n(b) an eligible day patient, namely, a day patient —\n\n(i) who is an eligible person; but\n\n(ii) who is not a compensable day patient;\n\nor\n\n(c) an ineligible day patient, namely, a day patient —\n\n(i) who is not an eligible person; and\n\n(ii) who is not a compensable day patient.\n\n(3) For the purposes of subclause (2)(a), a compensable day patient includes a person in respect of the payment for whose health services one or more of the following applies or appears prima facie to apply —\n\n(a) the *Workers Compensation and Injury Management Act 2023*;\n\n(ab) the *Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016*;\n\n(b) the *Motor Vehicle (Third Party Insurance) Act 1943*;\n\n(c) the law of Australia relating to the Defence Force within the meaning of the *Defence Act 1903* (Commonwealth).\n\n[Clause 13 amended: Gazette 9 Mar 2018 p. 798; SL 2023/87 cl. 9; SL 2024/81 cl. 4; SL 2024/104 cl. 4.]\n\n##### 14. Classes of out‑patients\n\n(1) An out‑patient must be classified under this clause for the purpose of the payment of the fees and charges set out in Schedule 1 in respect of an out‑patient.\n\n(2) An out‑patient must be classified as —\n\n(a) a compensable out‑patient; or\n\n(b) an eligible veteran out‑patient, namely, an out‑patient —\n\n(i) who is a veteran; and\n\n(ii) who elects to be treated under the DVA arrangement;\n\nor\n\n(c) an eligible out‑patient, namely, an out‑patient —\n\n(i) who is an eligible person; but\n\n(ii) who is not a compensable out‑patient or eligible veteran out‑patient;\n\nor\n\n(d) an ineligible out‑patient, namely, an out‑patient —\n\n(i) who is not an eligible person; and\n\n(ii) who is not a compensable out‑patient or eligible veteran out‑patient;\n\nor\n\n(e) a concessional beneficiary, namely, an out‑patient —\n\n(i) who is a concessional beneficiary (as defined in the National Health Act section 84); or\n\n(ii) who is a dependant as defined by that section of such a concessional beneficiary;\n\nor\n\n(f) a pensioner, namely, an out‑patient who holds a pensioner concession card or a dependant (as defined in the National Health Act section 84) of such an out‑patient.\n\n(3) At the time of —\n\n(a) attendance at a hospital for the purposes of receiving a pathology service provided by the hospital as an out‑patient service; or\n\n(b) receiving a pathology service provided by a hospital elsewhere than at the hospital,\n\nor as soon as practicable after that time, an eligible person (not being a compensable patient or a veteran), a concessional beneficiary or a pensioner may elect to be treated as a private pathology out‑patient for the purpose of that pathology service.\n\n(4) If a person makes an election under subclause (3), then —\n\n(a) the person is classified as a private pathology out‑patient for the purpose of the payment of any charge for that pathology service fixed in Schedule 1 Division 4; and\n\n(b) despite subclause (2)(c), (e) or (f), the person is not classified as an eligible out‑patient, concessional beneficiary or pensioner (as the case may be) for that purpose.\n\n(5) For the purposes of subclause (2)(a), a compensable out‑patient includes a person in respect of the payment for whose health services one or more of the following applies or appears prima facie to apply —\n\n(a) the *Workers Compensation and Injury Management Act 2023*;\n\n(ab) the *Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016*;\n\n(b) the *Motor Vehicle (Third Party Insurance) Act 1943*;\n\n(c) the law of Australia relating to the Defence Force within the meaning of the *Defence Act 1903* (Commonwealth).\n\n[Clause 14 amended: Gazette 9 Mar 2018 p. 798; SL 2023/87 cl. 10; SL 2024/81 cl. 4; SL 2024/104 cl. 4.]\n\n##### 15. Classes of same day patients\n\n(1) A same day patient must be classified under this clause for the purpose of the payment of the fees and charges set out in Schedule 1 in respect of a same day patient.\n\n(2) A same day patient must be classified as —\n\n(a) a public same day patient, namely, a same day patient who is an eligible person (not being a compensable same day patient, an eligible veteran same day patient or a same day patient who elects to be treated as a private same day patient); or\n\n(b) a private same day patient, namely, a same day patient who is an eligible person (not being a compensable same day patient) and who elects to be treated as a private same day patient; or\n\n(c) a compensable same day patient; or\n\n(d) an eligible veteran same day patient, namely, a same day patient —\n\n(i) who is a veteran; and\n\n(ii) who elects to be treated under the DVA arrangement;\n\nor\n\n(e) an ineligible same day patient, namely, a same day patient —\n\n(i) who is not an eligible person; and\n\n(ii) who is not a compensable same day patient.\n\n(3) At the time of admission to a hospital, or as soon as practicable after admission, an eligible person (not being a compensable same day patient or veteran) must elect whether the person wishes to be classified as a —\n\n(a) public same day patient; or\n\n(b) private same day patient.\n\n(4) At the time of admission to a hospital, or as soon as practicable after admission, a veteran must elect whether the veteran wishes to be classified as —\n\n(a) an eligible veteran same day patient; or\n\n(b) a public same day patient; or\n\n(c) a private same day patient.\n\n(5) For the purposes of subclause (2)(c), a compensable same day patient includes a person in respect of the payment for whose health services one or more of the following applies or appears prima facie to apply —\n\n(a) the *Workers Compensation and Injury Management Act 2023*;\n\n(ab) the *Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016*;\n\n(b) the *Motor Vehicle (Third Party Insurance) Act 1943*;\n\n(c) the law of Australia relating to the Defence Force within the meaning of the *Defence Act 1903* (Commonwealth).\n\n[Clause 15 amended: Gazette 9 Mar 2018 p. 798; SL 2023/34 cl. 7; SL 2023/87 cl. 11; SL 2024/81 cl. 4; SL 2024/104 cl. 4.]\n\nSchedule 1 — Fees and charges\n\n[cl. 4]\n\n[Heading amended: SL 2023/87 cl. 12.]\n\nDivision 1 — General\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\nSubdivision 1 — In‑patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 1. | Accommodation, maintenance, nursing care and other services — |  |\n| --- | --- | --- |\n|  | (a) for public in‑patients | no charge |\n|  | (b) for private in‑patients —<br> (i) in single bed wards (if taken at patient’s request)    <br> (ii) in other wards | no more than $755 per day<br>$446 per day |\n|  | (c) for nursing home type patients | $80.95 per day |\n|  | (d) for nursing home type private patients | $236.10 per day |\n|  | (e) for ineligible in‑patients | $3 118 per day |\n|  | (f) for eligible veteran in‑patients | no charge |\n| 2. | Home modifications service and supply or loan as appropriate, of such aids and appliances, orthotics and prostheses, oxygen, gas and equipment, wigs, surgical implants or devices as are approved by the Department CEO (including repair and replacement) | no charge |\n\n\nSubdivision 2 — Day patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 3. | Accommodation, maintenance and other services for eligible day patients | no charge |\n| --- | --- | --- |\n\n\nSubdivision 3 — Out‑patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 4. | Out‑patients service, except for medicines referred to in item 5 — |  |\n| --- | --- | --- |\n|  | (a) for eligible out‑patients and eligible veteran out‑patients | no charge |\n|  | (b) for ineligible out‑patients — for each individual service rendered | $391 |\n| 5. | Medicines, for each item — |  |\n|  | (a) for holders of an entitlement card | no charge |\n|  | (b) for other people who are —<br> (i) veterans who hold a Gold Card or a White Card; or<br> (ii) pensioners; or<br> (iii) concessional beneficiaries | <br>no more than $7.70 |\n|  | (c) for all other people (other than ineligible out‑patients) —<br> (i) at a participating hospital for an item on the PBS list     <br> (ii) at a participating hospital for an item not on the PBS list    <br> (iii) at a hospital that is not a participating hospital | PBS price up to a maximum of $31.60   <br>no more than $25.30<br>   no more than $25.30 |\n\n\nSubdivision 4 — Same day patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 6. | Same day health service, other than a service subject to a charge set out in this Schedule and associated with the provision of such service — |  |\n| --- | --- | --- |\n|  | (a) for public same day patients | no charge |\n|  | (b) for private same day patients | $368 per day |\n|  | (c) for eligible veteran same day patients | no charge |\n|  | (d) for ineligible same day patients | $3 087 per day |\n\n\nSubdivision 5 — Other services\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 7. | Accommodation for persons accompanying patients (except when parent accompanies sick child for medical wellbeing of sick child or breastfeeding, or when breastfed child accompanies sick mother) | $45 per day |\n| --- | --- | --- |\n\n\n[Division 1 inserted: SL 2024/104 cl. 5; amended: SL 2024/170 cl. 4; SL 2024/235 cl. 4; SL 2025/75 cl. 4; SL 2025/126 cl. 4; SL 2025/219 cl. 4.]\n\nDivision 2 — Compensable patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\nSubdivision 1 — Compensable in‑patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 1. | Accommodation, maintenance, nursing care and other services in a hospital bed, except services referred to in item 5 or 6 | $3 187 per day |\n| --- | --- | --- |\n| 2. | Accommodation, maintenance, nursing care and other services in a hospital bed for a patient, not being a patient mentioned in item 3, in respect of whose health services the *Motor Vehicle (Third Party Insurance) Act 1943* applies or prima facie appears to apply | no charge |\n| 3. | Accommodation, maintenance, nursing care and other services in a hospital bed for a patient in Perth Children’s Hospital in respect of whose health services the *Motor Vehicle (Third Party Insurance) Act 1943* applies or prima facie appears to apply | no charge |\n| 4. | Accommodation, maintenance, nursing care and other services in a nursing home bed | $368 per day |\n| 5. | Accommodation, maintenance, nursing care and other services in a hospital bed for a ventilator dependent compensable in‑patient with tracheostomy requiring 24 hour a day individual care | $7 026 per day |\n| 6. | Accommodation, maintenance, nursing care and other services in a hospital bed for a patient requiring 24 hour a day care for airway management, with or without tracheostomy | $4 200 per day |\n\n\nSubdivision 2 — Compensable out‑patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 7. | For radiological service — for each item of service | $391 |\n| --- | --- | --- |\n| 8. | For medicines, subject to item 9, for each item —<br>(a) at a participating hospital for an item on the PBS list     <br>(b) at a participating hospital for an item not on the PBS list<br>(c) at a hospital that is not a participating hospital | PBS price up to a maximum of $31.60<br>   $25.30<br>   $25.30 |\n| 9. | For each other individual service (with any medicines supplied at the time of the initial service being treated as included in that service) | $391 |\n\n\nSubdivision 3 — Compensable same day patients\n\n[Heading inserted: SL 2024/104 cl. 5.]\n\n| 10. | Same day treatment in hospitals, other than day hospitals, nursing homes and nursing posts —<br>(a) for a patient, not being a patient mentioned in paragraph (b), in respect of whose health services the *Motor Vehicle (Third Party Insurance) Act 1943* applies or prima facie appears to apply | no charge |\n| --- | --- | --- |\n|  | (b) for a patient in Perth Children’s Hospital in respect of whose health services the *Motor Vehicle (Third Party Insurance) Act 1943* applies or prima facie appears to apply | no charge |\n|  | (c) for any other patient | $4 173 per day |\n\n\n[Division 2 inserted: SL 2024/104 cl. 5; amended: SL 2024/170 cl. 5; SL 2025/126 cl. 4.]\n\nDivision 3 — Magnetic resonance imaging\n\nCharges for magnetic resonance imaging services\n\n| **Item** | **Service** | **Charge    (per study)** |\n| --- | --- | --- |\n| 1. | For a magnetic resonance study of — |  |\n|  | (a) one region of the body | $1 735 |\n|  | (b) 2 contiguous regions of the body | $1 735 |\n|  | (c) 2 or more separate regions of the body | $3 465 |\n|  | (d) 3 or more contiguous regions of the body | $3 465 |\n| 2. | If Gadolinium used as a contrast medium an   additional charge | $205 |\n\n\n[Division 3 amended: SL 2021/35 cl. 4.]\n\nDivision 4 — Pathology services\n\nIn the Table —\n\nMBS amount, for a pathology service, means the amount of the fee specified in the item for that pathology service in the Medicare Benefits Schedule.\n\nTable\n\n| **Item** | **Charge** |\n| --- | --- |\n| 1. | The MBS amount for the service if the service is provided to —<br> (a) a private in‑patient; or<br> (b) a compensable in‑patient; or<br> (c) a nursing home type private patient; or<br> (d) an ineligible in‑patient; or<br> (e) a compensable day patient; or<br> (f) an ineligible day patient; or<br> (g) a compensable out‑patient; or<br> (h) an ineligible out‑patient; or<br> (i) a private same day patient; or<br> (j) a compensable same day patient; or<br> (k) an ineligible same day patient. |\n| 2. | If the service is provided to a private pathology out‑patient — 85% of the MBS amount for the service. |\n\n\n[Division 5 deleted: SL 2020/58 cl. 7.]\n\nDivision 6 — Surgically implanted prostheses\n\n1. In the Table —\n\nlisted amount, in relation to a surgically implanted prosthesis, means the amount specified for that prosthesis in the Prostheses List in the column under the heading “Minimum Benefit”;\n\nProstheses List means the Schedule to the Private Health Insurance (Prostheses) Rules (Commonwealth) as in force from time to time.\n\nTable\n\n| **Item** | **Description** | **Charge** |\n| --- | --- | --- |\n| 1. | The supply of a surgically implanted prosthesis specified in the Prostheses List under the heading “CARDIO THORACIC” | 92.5% of the listed amount |\n| 2. | The supply of a surgically implanted prosthesis specified in the Prostheses List under the heading “OPHTHALMIC” | 80% of the listed amount |\n| 3. | The supply of a surgically implanted prosthesis not mentioned in item 1 or 2 but otherwise specified in the Prostheses List | the listed amount |\n\n\n![dline]()\n\nNotes\n\nThis is a compilation of the *Health Services (Fees and Charges) Order 2016* and includes amendments made by other written laws. For provisions that have come into operation see the compilation table.\n\nCompilation table\n\n| **Citation** | **Published** | **Commencement** |\n| --- | --- | --- |\n| *Health Services (Fees and Charges) Order 2016* | 1 Jul 2016 p. 2775-811 | 1 Jul 2016 (see cl. 2 and *Gazette* 24 Jun 2016 p. 2291) |\n| *Health Services (Fees and Charges) Amendment Order 2016* | 21 Oct 2016 p. 4783 | cl. 1 and 2: 21 Oct 2016 (see cl. 2(a));   Order other than cl. 1 and 2: 22 Oct 2016 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2017* | 3 Feb 2017 p. 1112‑13 | cl. 1 and 2: 3 Feb 2017 (see cl. 2(a));   Order other than cl. 1 and 2: 4 Feb 2017 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2017* | 5 May 2017 p. 2369 | cl. 1 and 2: 5 May 2017 (see cl. 2(a));   Order other than cl. 1 and 2: 6 May 2017 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2017* | 30 Jun 2017 p. 3566‑7 | cl. 1 and 2: 30 Jun 2017 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2017 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 5) 2017* | 22 Sep 2017 p. 4933 | cl. 1 and 2: 22 Sep 2017 (see cl. 2(a));   Order other than cl. 1 and 2: 23 Sep 2017 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2018* | 2 Feb 2018 p. 315‑16 | cl. 1 and 2: 2 Feb 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 3 Feb 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2018* | 9 Mar 2018 p. 797‑9 | cl. 1 and 2: 9 Mar 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 10 Mar 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2018* | 27 Apr 2018 p. 1392‑3 | cl. 1 and 2: 27 Apr 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 28 Apr 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2018* | 11 May 2018 p. 1503 | cl. 1 and 2: 11 May 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 12 May 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 6) 2018* | 25 May 2018 p. 1631‑2 | cl. 1 and 2: 25 May 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 5) 2018* | 12 Jun 2018 p. 1895 | cl. 1 and 2: 12 Jun 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 13 Jun 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No.7) 2018* | 13 Nov 2018 p. 4432 | cl. 1 and 2: 13 Nov 2018 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Dec 2018 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2019* | 26 Feb 2019 p. 439‑40 | cl. 1 and 2: 26 Feb 2019 (see cl. 2(a));   Order other than cl. 1 and 2: 27 Feb 2019 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2019* | 7 May 2019 p. 1351 | cl. 1 and 2: 7 May 2019 (see cl. 2(a));   Order other than cl. 1 and 2: 8 May 2019 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2019* | 7 Jun 2019 p. 1826‑7 | cl. 1 and 2: 7 Jun 2019 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2019 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 5) 2019* | 27 Sep 2019 p. 3419 | cl. 1 and 2: 27 Sep 2019 (see cl. 2(a));   Order other than cl. 1 and 2: 28 Sep 2019 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2020* | SL 2020/5 7 Feb 2020 | cl. 1 and 2: 7 Feb 2020 (see cl. 2(a));   Order other than cl. 1 and 2: 8 Feb 2020 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2020* | SL 2020/19 24 Mar 2020 | cl. 1 and 2: 24 Mar 2020 (see cl. 2(a));   Order other than cl. 1 and 2: 25 Mar 2020 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2020* | SL 2020/58 19 May 2020 | cl. 1 and 2: 19 May 2020 (see cl. 2(a));   Order other than cl. 1 and 2: 20 May 2020 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2020* | SL 2020/102 30 Jun 2020 | cl. 1 and 2: 30 Jun 2020 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2020 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2021* | SL 2021/20 9 Feb 2021 | cl. 1 and 2: 9 Feb 2021 (see cl. 2(a));   Order other than cl. 1 and 2: 10 Feb 2021 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2021* | SL 2021/35 9 Apr 2021 | cl. 1 and 2: 9 Apr 2021 (see cl. 2(a));   Order other than cl. 1 and 2: 10 Apr 2021 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2021* | SL 2021/134 27 Jul 2021 | cl. 1 and 2: 27 Jul 2021 (see cl. 2(a));   Order other than cl. 1 and 2: 28 Jul 2021 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 5) 2021* | SL 2021/194 26 Nov 2021 | cl. 1 and 2: 26 Nov 2021 (see cl. 2(a));   Order other than cl. 1 and 2: 27 Nov 2021 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2022* | SL 2022/9 11 Feb 2022 | cl. 1 and 2: 11 Feb 2022 (see cl. 2(a));   Order other than cl. 1 and 2: 12 Feb 2022 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2022* | SL 2022/55 20 May 2022 | cl. 1 and 2: 20 May 2022 (see cl. 2(a));   Order other than cl. 1 and 2: 21 May 2022 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2022* | SL 2022/110 28 Jun 2022 | cl. 1 and 2: 28 Jun 2022 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2022 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2022* | SL 2022/166 18 Oct 2022 | cl. 1 and 2: 18 Oct 2022 (see cl. 2(a));   Order other than cl. 1 and 2: 19 Oct 2022 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2023* | SL 2023/6 3 Feb 2023 | cl. 1 and 2: 3 Feb 2023 (see cl. 2(a));   Order other than cl. 1 and 2: 4 Feb 2023 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2023* | SL 2023/34 2 May 2023 | cl. 1 and 2: 2 May 2023 (see cl. 2(a));   Order other than cl. 1 and 2: 3 May 2023 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2023* | SL 2023/55 23 May 2023 | cl. 1 and 2: 23 May 2023 (see cl. 2(a));   Order other than cl. 1 and 2: 24 May 2023 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 5) 2023* | SL 2023/86 30 Jun 2023 | cl. 1 and 2: 30 Jun 2023 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2023 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2023* | SL 2023/87 30 Jun 2023 | cl. 1 and 2: 30 Jun 2023 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2023 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 6) 2023* | SL 2023/178 8 Nov 2023 | cl. 1 and 2: 8 Nov 2023 (see cl. 2(a));   Order other than cl. 1 and 2: 9 Nov 2023 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2024* | SL 2024/7 2 Feb 2024 | cl. 1 and 2: 2 Feb 2024 (see cl. 2(a));   Order other than cl. 1 and 2: 3 Feb 2024 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2024* | SL 2024/74 8 May 2024 | cl. 1 and 2: 8 May 2024 (see cl. 2(a));   Order other than cl. 1 and 2: 9 May 2024 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2024* | SL 2024/81 22 May 2024 | cl. 1 and 2: 22 May 2024 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2024 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 4) 2024* | SL 2024/104 17 Jun 2024 | cl. 1 and 2: 17 Jun 2024 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2024 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 5) 2024* | SL 2024/170 20 Aug 2024 | cl. 1 and 2: 20 Aug 2024 (see cl. 2(a));   Order other than cl. 1 and 2: 21 Aug 2024 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 6) 2024* | SL 2024/235 19 Nov 2024 | cl. 1 and 2: 19 Nov 2024 (see cl. 2(a));   Order other than cl. 1 and 2: 20 Nov 2024 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order 2025* | SL 2025/75 19 May 2025 | cl. 1 and 2: 19 May 2025 (see cl. 2(a));   Order other than cl. 1 and 2: 20 May 2025 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 2) 2025* | SL 2025/126 27 Jun 2025 | cl. 1 and 2: 27 Jun 2025 (see cl. 2(a));   Order other than cl. 1 and 2: 1 Jul 2025 (see cl. 2(b)) |\n| *Health Services (Fees and Charges) Amendment Order (No. 3) 2025* | SL 2025/219 22 Dec 2025 | cl. 1 and 2: 22 Dec 2025 (see cl. 2(a));   Order other than cl. 1 and 2: 23 Dec 2025 (see cl. 2(b)) |\n\n\nDefined terms\n\n*[This is a list of terms defined and the provisions where they are defined. The list is not part of the law.]*\n\n**Defined term Provision(s)**\n\nadult chargeable patient 9(1)\n\nasylum seeker 3(1)\n\nBenefits Schedule 3(1)\n\nchargeable patient 9(1)\n\nchild chargeable patient 9(1)\n\ncompensable day patient 3(1), 3A(1)\n\ncompensable in-patient 3(1), 3A(2)\n\ncompensable out-patient 3(1), 3A(3)\n\ncompensable patient 3(1)\n\ncompensable same day patient 3(1), 3A(4)\n\nconcessional beneficiary 3(1)\n\nday hospital 3(1)\n\nday patient 3(1)\n\nDVA arrangement 3(1)\n\neligible day patient 3(1)\n\neligible out-patient 3(1)\n\neligible person 3(1)\n\neligible veteran in-patient 3(1)\n\neligible veteran out-patient 3(1)\n\neligible veteran same day patient 3(1)\n\nentitlement card 3(1)\n\nGold Card 3(1)\n\nhospital 3(1)\n\nhospital bed 3(1)\n\nineligible day patient 3(1)\n\nineligible in-patient 3(1)\n\nineligible out-patient 3(1)\n\nineligible same day patient 3(1)\n\nin-patient 3(1)\n\ninternal Territory 3(1)\n\ninvoluntary patient 3(1) and (3)\n\nlisted amount Sch. 1\n\nMBS amount Sch. 1\n\nMedicare 3(1)\n\nMedicare ineligible asylum seeker 3(1)\n\nMedicare ineligible involuntary patient 3(1)\n\nmidwife 3(1)\n\nmidwifery service 3(1)\n\nNational Health Act 3(1)\n\nnursing home bed 3(1)\n\nnursing home type patient 3(1)\n\nnursing home type private patient 3(1)\n\nout-patient 3(1)\n\nparticipating hospital 3(1)\n\nPBS list 3(1)\n\nPBS price 3(1)\n\npensioner 3(1)\n\npensioner concession card 3(1)\n\nprivate in-patient 3(1)\n\nprivate pathology out-patient 3(1)\n\nprivate same day patient 3(1)\n\nprofessional service 3(1)\n\nProstheses List Sch. 1\n\nprovider hospital 7(1), 10(1)\n\npublic in-patient 3(1)\n\npublic same day patient 3(1)\n\nsame day patient 3(1)\n\nsurgically implanted prosthesis 3(1)\n\nveteran 3(1)\n\nWhite Card 3(1)\n\n© State of Western Australia 2025.\n\nThis work is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY 4.0). To view relevant information and for a link to a copy of the licence, visit www.legislation.wa.gov.au.\n\nAttribute work as: © State of Western Australia 2025.\n\nBy Authority: ROGER JACOBS, Acting Government Printer\n","sortOrder":0}],"analysis":{"issue_detection":{"absurdities":[],"contradictions":[]},"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"},"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":true,"description":"Yes. The Order has materially expanded and become more detailed since its original purpose of fixing hospital fees. Amendments over time have added: (a) new classifications and administrative discretions (for example clause 3A on compensable patients inserted in 2023), (b) explicit exemptions (clause 6A for Medicare‑ineligible asylum seekers and involuntary patients), (c) delegation of price‑setting for certain items to the Department CEO (cl. 9, 10A), and (d) more granular fee divisions in Schedule 1 (new Divisions and Subdivisions added 2024 onwards). These changes move the instrument from a relatively simple fee list to a comprehensive charging regime that integrates Commonwealth schedules, creates operational decision points for hospital executives and the Department CEO, and distinguishes many narrow patient classes — substantially broadening the administrative scope and discretion of the Order."},"complexity_factors":["Approximately 60 defined terms in the interpretation section (cl. 3 and Defined terms list) creating many cross‑classifications","Multiple patient classifications (in‑patient, day, out‑patient, same‑day) each subdivided into eligible/private/compensable/ineligible/veteran — nested classifications in Part 3 (cls. 11–15)","Schedule 1 with multiple divisions and many specific line items (Divs. 1–6, subdivided into in‑patient/day/out‑patient/same‑day/compensable/MRI/pathology/prostheses)","Frequent cross‑references to Commonwealth legislation and schedules (Health Insurance Act, National Health Act, PBS list, Medicare Benefits Schedule, Prostheses List) which import external changes and add dependency","Delegated pricing powers and publication requirements (Department CEO determinations for orthoses and medicines — cl. 9(2), 10A(1))","Operational discretion at the hospital level (chief executive can decide compensable status — cl. 3A(5); Minister can designate nursing home beds — cl. 3(2))","Conditional exceptions and carve‑outs (e.g. Medicare ineligible asylum seekers and involuntary mental‑health patients exempted — cl. 6A and cl. 11(2))","Numerous amendments over time and rolling updates to Schedule 1 (see compilation table), which increase interpretive complexity and the need to check current versions"],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- Fixes the fees and charges that apply to health services provided in Western Australian public hospitals under the Health Services Act 2016 (see cl. 4 and Schedule 1).\n- Organises patients into detailed classes (public/private/eligible/ineligible/compensable/veteran/day/out‑patient/same‑day) and links each class to particular fees or exemptions (Part 3: cls. 11–15; Schedule 1).  \n- Provides specific charging rules for particular services: magnetic resonance imaging (MRI) (cl. 7 and Sch. 1 Div. 3), pathology (cl. 8 and Sch. 1 Div. 4), surgically implanted prostheses (cl. 10 and Sch. 1 Div. 6), specialised orthoses (cl. 9) and provision of medicines (cl. 10A).\n- Delegates some price-setting to officials: the Department CEO may set the charge for specialised orthoses (cl. 9(2)) and for medicines supplied to certain ineligible patients (cl. 10A(1)); those determinations must be published (cl. 9(3), 10A(2)).\n- Allows hospital chief executives a limited discretion to determine that a person who appears to be a compensable patient is not, in fact, to be treated as compensable for the particular services (cl. 3A(5)).\n- Creates narrow exemptions: Medicare ineligible asylum seekers and Medicare ineligible involuntary mental‑health patients receive services free of charge in specified circumstances (cl. 6A; cl. 11(2)).\n\n**Who this affects**\n\n- Patients using public hospitals in Western Australia, classified into many legally defined categories (see cl. 3 for defined terms and Part 3 for classes).  \n  - \"Eligible persons\" (i.e. generally Medicare‑covered Australians) may be treated as public or private patients and have different entitlements and fees (cl. 12, Sch. 1 Div. 1).  \n  - \"Ineligible\" patients (not Medicare eligible) face separate, usually higher, fixed charges (see Sch. 1 Divs. 1 & 3).  \n  - \"Compensable\" patients (e.g. injuries covered by workers’ compensation, motor vehicle third‑party insurance, Defence arrangements) are treated under Division 2 of Schedule 1 with its own fee structure (cl. 3A; Sch. 1 Div. 2).  \n  - Veterans, pensioners and concession card holders have specific treatment in the schedule (Part 3; Sch. 1 Divs. 1–4).  \n- Hospital operators and the WA Department of Health, who must implement classifications, collect fees, publish CEO determinations and apply the limited discretions granted (cls. 3A(5), 9(3), 10A(2)).\n- Third‑party payers (insurance, compensation bodies, DVA) because the Order distinguishes services that should be charged to a compensable payer versus to the patient directly (cl. 3A; Sch. 1 Div. 2).\n\n**Why it matters (practical effects and mechanisms)**\n\n- Establishes who pays and how much: the Order turns broad statutory authority (s.56 Health Services Act) into concrete dollar amounts or pricing rules (cl. 4; Schedule 1).  For example, many public in‑patient services are set at no charge, while ineligible in‑patients have published daily charges (Sch. 1 Div. 1 items 1(e)).\n- Allocates collection and administrative burdens: hospitals must classify patients (Part 3), collect payments where applicable, and apply CEO determinations and exemptions. That creates administrative work (patient elections, verification of eligibility, dealing with compensable claims) and potential recovery tasks when third parties should pay (cl. 3A and Sch. 1 Div. 2).\n- Links some prices to Commonwealth lists (Medicare Benefits Schedule, PBS, Prostheses List) so changes at the Commonwealth level feed through automatically to some charges (cl. 3 definitions; Sch. 1 Div. 4 and Div. 6). This reduces the need for parallel pricesetting but ties WA fees to Commonwealth schedule changes.\n- Introduces official discretion and conditional rules that affect predictability: the Department CEO sets some charges (cl. 9(2), 10A(1)) and hospital chief executives can reclassify compensable status for fairness or administrative reasons (cl. 3A(5)). These mechanisms balance central price control with local operational judgement, but introduce room for variation in application.\n\n**Costs, incentives and trade‑offs (concrete mechanisms)**\n\n- Who pays: the Order explicitly assigns costs either to the patient (ineligible or private patients), to the public purse (public in‑patients, many veterans), or to compensable payers (workers’ comp, motor vehicle third‑party, Defence) depending on classification (Part 3; Sch. 1 Divs. 1–2).  This creates concentrated beneficiaries (e.g. eligible public patients, veterans) and concentrated payers (compensable schemes) as well as diffuse costs (administration across all hospitals).\n- Incentives for patient choice: eligible persons must elect public or private status on admission (cl. 12(4), cl. 15(3)), which affects fees and the professional services they may obtain in private capacity — this preserves patient choice but requires active election and verification.\n- Administrative and compliance burden: detailed classifications and cross‑references (to Commonwealth Acts and to other WA legislation) require verification of eligibility, compensation entitlements and card status; collecting and reconciling charges with third‑party payers increases hospital administrative workload (Part 3; cl. 3A; Sch. 1).\n- Pricing transparency vs discretion: some prices are fixed in the Schedule (e.g. MRI charges in Sch. 1 Div. 3) while others are set by the Department CEO based on cost (cl. 9(2), 10A(1)). Fixed prices aid predictability; CEO determinations allow cost recovery but create a need to check published determinations.\n- Possible substitution effects and interactions with private sector: the Order treats private patients and private pathology differently (e.g. private pathology out‑patients pay 85% of MBS; Sch. 1 Div. 4). That can influence patient choice between public hospital private treatment and fully private providers, with potential flow‑on effects on demand for private health insurance and private providers.\n\n**Implementation risks and points of discretion**\n\n- Misclassification risk: incorrect patient classification (eligible vs ineligible, compensable vs non‑compensable) will cause incorrect charging and potential disputes (Part 3; cl. 3A(5)).\n- Discretionary decision points: hospital chief executives can decide not to treat a person as compensable in particular circumstances (cl. 3A(5)); the Minister can designate nursing home beds as hospital beds (cl. 3(2)); the Department CEO sets some charges (cl. 9(2), 10A(1)). These give administrative flexibility but require governance to avoid inconsistent application.\n- Dependence on Commonwealth schedules: several fees are a function of Commonwealth lists (MBS, PBS, Prostheses List). Federal changes affect WA fees without separate WA amendment (cl. 3 definitions; Sch. 1 Divs. 4 & 6), which reduces duplication but reduces state control over those specific figures.\n\n**Where to look in the instrument**\n\n- Definitions and classes of patients: cl. 3 and Part 3 (cls. 11–15).\n- Core fee authority and list of fees: cl. 4 and Schedule 1 (Divisions 1–6).\n- Compensable patient rules and hospital chief executive discretion: cl. 3A and Schedule 1 Division 2.\n- Special pricing mechanisms (orthoses, medicines): cl. 9 and cl. 10A.\n- MRI and pathology specific charging rules: cl. 7–8 and Schedule 1 Divs. 3–4.\n\n(Sections cited above are the relevant clauses and schedule references in the Health Services (Fees and Charges) Order 2016.)"},"summary":{"complexity_score":2,"scope_assessment":{"changed":false,"description":"Scope cannot be assessed as the substantive content of the legislation was not available for review. Only a website error/redirect notice was provided. No comparison between original intent and final form is possible."},"complexity_factors":["Insufficient legislative content available — only an error page was retrieved, preventing meaningful complexity assessment","Fee and charges orders are typically moderately complex due to tiered pricing structures, but this cannot be confirmed","The order may cross-reference other health legislation (e.g., Health Services Act 2016 WA), which would add complexity"],"plain_english_summary":"This order sets the schedule of fees and charges for Western Australia public health services — who pays what for hospital and related care — and therefore affects patients, insurers and other payers. The live instrument is currently inaccessible at the provided link, so anyone impacted (e.g., disputing a bill) should consult the WA Parliamentary Counsel’s Office website for the current version."},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":true,"description":"Originally a straightforward fee-setting instrument, the legislation has expanded significantly to address complex policy areas. It now incorporates detailed provisions for asylum seekers (2023), involuntary mental health patients (2023), catastrophic injury schemes (2024), and specialised high-cost care like ventilator-dependent patients. The 'compensable patient' framework has grown from simple workers' compensation coverage to include motor vehicle insurance, military compensation, and discretionary administrative decisions about fairness. The Schedule has also evolved from simple daily rates to complex service-specific charges for MRIs, prostheses, and pathology with percentage-based calculations."},"complexity_factors":["47 defined terms in clause 3(1) alone, with additional definitions scattered throughout other clauses","Nested patient classifications: 4 main patient types (in-patient, day patient, out-patient, same day patient) each with 5-7 sub-classifications","Extensive cross-referencing to Commonwealth legislation (Health Insurance Act, Migration Act, Veterans' Entitlements Act, etc.) requiring external knowledge","Conditional logic with multiple exceptions: clause 5(2) lists 4 exceptions to general fees; clause 6(2) lists 3 exceptions to compensable patient fees","Complex eligibility criteria for 'compensable patients' involving prima facie assessments and administrative decisions under clause 3A(5)","Multiple fee schedules with overlapping applicability (Schedule 1 Divisions 1-6) requiring careful matching of patient class to service type","Frequent amendments (42 amendment instruments listed in compilation table) creating layered historical context","Specific carve-outs for particular hospitals (Perth Children's Hospital) and specific medical conditions (ventilator-dependent patients)"],"plain_english_summary":"This Western Australian law sets out the fees and charges that public hospitals can charge patients for healthcare services. It works by first sorting patients into different categories (like public in-patients, private patients, veterans, or people covered by workers' compensation), then applying specific fees to each category.\n\n**Key things it does:**\n\n*   **Sets hospital fees:** It lists exactly how much hospitals can charge for accommodation, nursing care, surgery, medicines, MRI scans, pathology tests, and prosthetic devices.\n*   **Protects vulnerable groups:** Some people pay nothing at all—including public patients with Medicare, veterans with DVA cards, asylum seekers without Medicare, and involuntary mental health patients.\n*   **Handles insurance cases:** Special rules apply to \"compensable patients\"—people whose treatment costs are covered by workers' compensation, motor vehicle insurance, or military compensation schemes. These patients (or their insurers) typically pay higher daily rates.\n*   **Charges non-Medicare patients:** People who aren't eligible for Medicare (such as overseas visitors without reciprocal coverage) face significant daily charges—up to $3,118 per day for in-patients.\n*   **Lets patients choose:** Eligible patients can elect to be treated as private patients (which may involve out-of-pocket costs) or public patients (generally free).\n\n**Why it matters:**\nThis Order determines what you'll pay if you go to a public hospital in Western Australia. Whether you walk out with no bill or a substantial one depends entirely on which category this law places you in."}},"importantCases":[],"_links":{"self":"/api/acts/health-services-fees-and-charges-order-2016","history":"/api/acts/health-services-fees-and-charges-order-2016/history","analysis":"/api/acts/health-services-fees-and-charges-order-2016/analysis","conflicts":"/api/acts/health-services-fees-and-charges-order-2016/conflicts","importantCases":"/api/acts/health-services-fees-and-charges-order-2016/important-cases","documents":"/api/acts/health-services-fees-and-charges-order-2016/documents"}}