//
© 2026 Zoe. All rights reserved.
Zoe is a legal information platform. Always consult the Federal Register of Legislation for authoritative text.
Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This regulation publishes the 1992–93 Medicare Benefits Schedule: an itemised price list and rulebook that determines which medical services the Australian government subsidises and how much Medicare pays. It sets eligibility, claiming rules, and payment calculations for a wide range of clinical care.
It directly affects patients (rebates), health practitioners (billing and qualification requirements), and facilities (service, location, and equipment conditions), essentially operationalising Medicare under the Health Insurance Act.
Want the full deep dive?
Zoe can write the in-depth analysis on top of the summary above: how it works, who it affects and what each part actually does.
Direct links to the current provisions in Health Insurance (1992-1993 General Medical Services Table) Regulations.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Statutory Rules 1992 No. 3381
__________________
Health Insurance (1992-1993 General Medical Services Table) Regulations
I, The Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.
Dated 20 October 1992.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
B. HOWE
Minister of State for Health, Housing and Community Services
____________
Citation
Commencement
Repeal
General medical services table
________________
SCHEDULE Regulation 4
TABLE OF GENERAL MEDICAL SERVICES
RULES OF INTERPRETATION
General
“attendance of a minor nature” or “minor attendance”, in relation to an attendance on a patient by a consultant physician, means an attendance that:
(a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and
(b) does not result in a substantial alteration to the treatment of the patient;
“institution” means a place (other than a hospital, a nursing home or accommodation for aged persons that is attached to a nursing home or situated within a nursing home complex) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or mentally handicapped persons;
“the Act” means the Health Insurance Act 1973.
SCHEDULE—continued
(2) In this table, a reference by number to an item in the series 65001 to 73921 (inclusive) is a reference to the item so numbered in the pathology services table.
(3) In this table, a reference by number to an item in the series 55000 to 61502 (inclusive) is a reference to the item so numbered in the diagnostic imaging services table.
(4) In this table, the symbol “(AU n)” (where n is a number) is explained in items 17901 to 17959 (inclusive).
(5) In these Rules, “referring practitioner”, in relation to a referral, means:
(a) in the case of all referrals—a medical practitioner; and
(b) if the referral is given to a specialist who is an ophthalmologist—an optometrist; and
(c) if the referral:
(i) arises out of a dental service given by a dental practitioner; and
(ii) is given to a specialist (but not a consultant physician);
a dental practitioner.
Meaning of symbols“(S)” and “(G)”
(a) to a patient who has been referred to the specialist, if the service is the first given by the specialist after the referral; or
(b) to a patient who has been referred to the specialist:
(i) if the service is part of a single course of treatment given for the condition identified in the referral; or
(ii) if no condition was identified in the referral—for the condition identified by the specialist; and
the service is given within the period of validity of the referral applicable under regulation 12 of the Health Insurance Regulations; or
(c) to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was given, if the service is the first given by the specialist in accordance with the referral; or
(d) to a patient who has not been referred to the specialist if, in an emergency, the specialist decides that it is necessary in the patient’s interests to give the service as soon as practicable without a referral.
SCHEDULE—continued
(2) An item including the symbol “(G)” applies only to a service given otherwise than by a specialist in accordance with subrule (1).
Meaning of “single course of treatment” in certain circumstances
(a) the:
(i) initial attendance by a specialist or consultant physician; and
(ii) continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(b) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or the specialist or consultant physician.
(2) For the purposes of subrule (1), an unrelated illness that requires referral of the patient to the specialist’s or consultant physician’s care, initiates a new course of treatment for which a new referral is required.
(3) For the purposes of subrule (1), if:
(a) a referring practitioner considers it necessary for a patient’s condition to be reviewed; and
(b) the patient is attended by the specialist or consultant physician after the end of the period of validity of the last referral applicable under regulation 12 of the Health Insurance Regulations; and
(c) the patient was last attended by the specialist or consultant physician more than 9 months before the attendance mentioned in paragraph (b);
the attendance mentioned in paragraph (b) initiates a new course of treatment.
Interpretation of items 104 to 159 (inclusive)
(a) includes an attendance by a specialist, or consultant physician, in the practice of his or her specialty:
(i) if the patient has declared that a written referral of the patient was completed by a medical practitioner
SCHEDULE—continued
(ii) if, in an emergency, the patient has not been referred to the specialist, or consultant physician, who decides that it is necessary in the patient’s interests to give the service mentioned in the item as soon as practicable without a referral; but
(b) does not include an attendance by a specialist, or consultant physician, in the practice of his or her specialty if:
(i) the attendance forms part of a single course of treatment in which the first service was given more than 12 months (or such other period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been given.
(2) In items 104 to 159 (inclusive), a reference to the referring of a patient to a specialist, or consultant physician, is a reference to the referring of a patient to a specialist, or consultant physician, by a referring practitioner.
Meaning of “professional attendance” in certain items
(a) the evaluation of the patient’s condition or conditions including, if applicable, evaluation using the health screening services mentioned in in subsection 19 (5) of the Act;
(b) the formulation of a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) the provision:
(i) of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment; and
(ii) if the patient has so authorised, of advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(d) the recording of the clinical details of the service or services given to the patient.
SCHEDULE—continued
Meaning of “Amount under rule 6” in certain items
(a) the fee set out in item 3; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(2) In items 25, 33 and 35, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 23; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(3) In items 38, 40 and 43, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 36; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(4) In items 48, 50 and 51, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 44; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
SCHEDULE—continued
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(5) In items 81, 87 and 92, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 52; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(6) In items 83, 89 and 93, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 53; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(7) In items 84, 90 and 95, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 54; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(8) In items 86, 91 and 96, “Amount under rule 6” means an amount equal to the sum of:
(a) the fee set out in item 57; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
SCHEDULE—continued
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
Items 10809 and 10929 not to apply in certain circumstances
(a) because the patient does not want to wear spectacles for reasons of appearance; or
(b) because the patient wants contact lenses for work, or sporting, purposes; or
(c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.
Application of items 10921 to 10929 (inclusive)
(2) The patient requires a change in contact lens material, or basic lens parameters, other than a simple power change, because of:
(a) a structural, or functional, change in the eye; or
(b) an allergic response.
(3) A lost, damaged or otherwise unsatisfactory contact lens is replaced by an optometrist:
(a) who:
(i) does not have access to the original prescription; and
(ii) does a total refit where an item mentioned in subrule (1) applies; and
(b) who is not:
(i) the optometrist who initially fitted the contact lenses; or
(ii) an optometrist at, or operating from, the same practice location at which the optometrist who initially fitted the contact lenses practised when the contact lenses were initially fitted.
SCHEDULE—continued
Personal attendance by medical practitioners generally
(2) The items are 3 to 153 (inclusive), 157 to 164 (inclusive), 173 to 10815 (inclusive), 11012, 11015, 11018, 11021, 11212, 11303, 11500, 11600, 11627, 11630, 11712, 11921, 12000, 12003, 12100, 12103, 12106, 12109, 12112, 12115, 13000, 13003, 13006, 13009, 13100, 13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312, 13315, 13318, 13400, 13500, 13503, 13600, 13603, 13606, 13700, 13703, 13706, 13709, 13800, 13803, 13806, 13900, 13903, 13906, 13909, 13912, 14200, 14203, 14206, 16000 to 16552 (inclusive) and 16558 to 51309 (inclusive).
(3) Items 154, 155, 156, 170, 171 and 172 apply only to a service given in the course of a personal attendance by a medical practitioner.
Personal attendance by certain medical practitioners
(a) a medical practitioner other than a medical practitioner employed by the proprietor of a hospital other than a private hospital; or
(b) a medical practitioner:
(i) who is employed by the proprietor of a hospital other than a private hospital; and
(ii) who gives the service otherwise than in the course of employment by that proprietor;
whether or not another person provides essential assistance to that medical practitioner in accordance with accepted medical practice.
(2) The items are 3 to 10815 (inclusive), 11012, 11015, 11018, 11021, 11212, 11303, 11500, 11600, 11627, 11630, 11712, 11921, 12000, 12003, 12100, 12103, 12106, 12109, 12112, 12115, 13000, 13003, 13006, 13009, 13100, 13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312, 13315, 13318, 13400, 13500, 13503, 13600, 13603, 13606, 13700, 13703, 13706, 13709, 13800, 13803, 13806, 13900, 13903, 13906, 13909, 13912, 14200, 14203, 14206, 16000 to 16552 (inclusive) and 16558 to 51309 (inclusive).
SCHEDULE—continued
Certain services may be given by persons other than medical practitioners
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who is employed by a medical practitioner or, in accordance with accepted medical practice, a
This is an opening excerpt, not the complete document.