1
Name of Determination \[see Note 1\]
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Allied Health Services) Determination 2007.
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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This Determination lists allied‑health services that Medicare will treat as both professional and medical services, sets the fee for each listed service, and prescribes who may provide them (qualification and registration rules) and how they must be referred and reported (see s.6; Schedules 1–2). It affects allied health practitioners, referring medical practitioners and patients using EPC/GP mental‑health or PDD plans by imposing credential checks, service‑duration and annual limits, referral/reporting obligations and a bar where private health insurance is claimed (see ss.8,9–11).
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Direct links to the current provisions in Health Insurance (Allied Health Services) Determination 2007.
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Allied Health Services) Determination 2007.
2 Commencement
This Determination commences as follows:
(a) on 1 November 2007 — sections 1 to 3 and 5 to 9 and Schedules 1 to 3;
(b) on 1 January 2008 — section 4 and Schedule 4.
3 Revocation
The Health Insurance (Allied Health and Dental Services) Determination 2006 is revoked.
4 Amendment of Health Insurance (Allied Health Services) Determination 2007
Schedule 4 amends the Health Insurance (Allied Health Services) Determination 2007.
5 Interpretation
(1) In this Determination:
Act means the Health Insurance Act 1973.
allied health professional, in relation to the provision of an allied health service, means a person:
(a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and
(b) whose name is entered in the register, kept by the Medicare Australia CEO, of allied health professionals who are qualified to provide a service of that kind.
allied health service means a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975 that is specified in an item in Schedule 2.
course of treatment means:
(a) for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:
(i) an eligible clinical psychologist;
(ii) an eligible psychologist;
(iii) an eligible occupational therapist;
(iv) an eligible social worker; and
(b) for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
(i) an eligible psychologist;
(ii) an eligible speech pathologist;
(iii) an eligible occupational therapist.
eligible Aboriginal health worker means a person who is an allied health professional in relation to the provision of an Aboriginal or Torres Strait Islander health service.
eligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.
eligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.
eligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.
eligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.
eligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(b) an occupational therapy health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
enhanced primary care multidisciplinary care plan, for a patient, means:
(a) a multidisciplinary care plan for the patient, to which item 731 of the general medical services table applies; or
(b) a multidisciplinary community care plan for the patient, to which item 720 of a relevant repealed general medical services table applied; or
(c) a multidisciplinary discharge care plan for the patient, to which item 722 of a relevant repealed general medical services table applied; or
(d) a multidisciplinary care plan for the patient, to which item 730 of a relevant repealed general medical services table applied.
EPC plan, in relation to a patient, means:
(a) an enhanced primary care multidisciplinary care plan for the patient; or
(b) a care plan for the patient comprising:
(i) a GP management plan to which item 721 of the general medical services table applies; and
(ii) team care arrangements to which item 723 of the general medical services table applies.
focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑ based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy that involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy;
(f) narrative therapy (for Aboriginal and Torres Strait Islander people).
GP management plan, for a patient, means a GP management plan to which item 721 or 725 of the general medical services table applies.
GP Mental Health Care Plan, in relation to a patient, means a GP Mental Health Care Plan for the patient to which item 2710 of the general medical services table applies.
multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the general medical services table applies.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
OT Australia means the national body of the Australian Association of Occupational Therapists.
PDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.
relevant repealed general medical services table means the table prescribed by any of the following Regulations:
(a) the Health Insurance (1999–2000 General Medical Services Table) Regulations 1999 as in force immediately before 1 November 2000;
(b) the Health Insurance (General Medical Services Table) Regulations 2000 as in force immediately before 1 November 2001;
(c) the Health Insurance (General Medical Services Table) Regulations 2001 as in force immediately before 1 November 2002;
(d) the Health Insurance (General Medical Services Table) Regulations 2002 as in force immediately before 1 November 2003;
(e) the Health Insurance (General Medical Services Table) Regulations 2003 as in force immediately before 1 November 2004;
(f) the Health Insurance (General Medical Services Table) Regulations 2004 as in force immediately before 1 November 2005.
Note The following terms are defined in subsection 3 (1) of the Act:
Note: dental practitioner
Note: general medical services table
Note: medical practitioner
Note: Medicare Australia CEO
Note: professional service.
(2) A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a woman by a health professional in which:
(a) information and issues relating to pregnancy are discussed; but
(b) the health professional does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.
6 Treatment of allied health services
An allied health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
8 Limitation on certain items
(1) For any particular patient, an item mentioned in subsection (2) applies in a calendar year only if the service described in the item is:
(a) one of the first 12 relevant services provided to the patient in the calendar year; or
(b) if exceptional circumstances exist in relation to the patient — one of the first 18 relevant services provided to the patient in the calendar year.
(2) The items are items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.
(3) In this section:
exceptional circumstances exist in relation to a patient if:
(a) the patient has, in a calendar year, received at least 12 relevant services; and
(b) the patient’s referring medical practitioner is satisfied that there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for a service described in an item mentioned in paragraph (a) of the definition of relevant service.
relevant service means a service:
(a) to which any of items 2721 to 2727 of the general medical services table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply; or
(b) to which the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care Program applies.
9 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
(1) This section applies to items 80000 to 80170 in Schedule 2.
(2) The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral of a service to which any of items 293 to 370 of the general medical services table apply.
(3) The referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral of a service to which any of items 110 to 133 of the general medical services table apply.
(4) The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral of a service to which any of items 104 to 109 of the general medical services table apply.
10 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
(1) This section applies to items 82000 to 82025 in Schedule 2.
(2) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the general medical services table apply.
(3) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table apply.
(4) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the general medical services table applies.
(5) If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the general medical services table apply.
(6) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral to which item 135 of the general medical services table applies.
(7) If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the general medical services table apply.
11 Effect of election to claim private health insurance for an allied health service
An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.
Schedule 1 Qualification requirements for allied health professionals
(section 5)
| 1. | Aboriginal or Torres Strait Islander health serviceA person is an allied health professional in relation to the provision of an Aboriginal or Torres Strait Islander health service if:(a) in the case of a person who provides an Aboriginal or Torres Strait Islander health service in a State or Territory other than the Northern Territory — the person has been awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework; or(b) in the case of a person who provides an Aboriginal or Torres Strait Islander health service in the Northern Territory — the person is registered under the Health Practitioners Act (NT). |
|---|---|
| 2. | Audiology health serviceA person is an allied health professional in relation to the provision of an audiology health service if the person is:(a) a Full Member of the Audiological Society of Australia and the holder of a Certificate of Clinical Practice issued by that Society; or(b) an Ordinary Member — Audiologist, or a Fellow Audiologist, of the Australian College of Audiology. |
| 3. | Chiropractic health serviceA person is an allied health professional in relation to the provision of a chiropractic health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 4. | Diabetes education health serviceA person is an allied health professional in relation to the provision of a diabetes education health service if the person is credentialled by the Australian Diabetes Educators Association as a ‘Credentialled Diabetes Educator’. |
| 5. | Dietetics health serviceA person is an allied health professional in relation to the provision of a dietetics health service if the person is accredited by the Dietitians Association of Australia as an ‘Accredited Practising Dietitian’. |
| 6. | Exercise physiology health serviceA person is an allied health professional in relation to the provision of an exercise physiology health service if the person is accredited by the Australian Association for Exercise and Sports Science as an ‘Accredited Exercise Physiologist’. |
| 7. | Focussed psychological strategies health serviceA person is an allied health professional in relation to the provision of a focussed psychological strategies health service if the person meets one of the following requirements:(a) the person is registered, without any limitation, with the Psychologists Registration Board established under the applicable law in force in the State or Territory in which the service is provided;(b) the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Competency Standards for Mental Health Social Workers 1999’, as in force on 1 November 2006;(c) the person:(i) is a Full‑time Member, or a Part‑time Member, of OT Australia; and(ii) is, in the case of a person who provides a focussed psychological strategies health service in Queensland, Western Australia, South Australia or the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and(iii) has a minimum of 2 years experience in mental health; and(iv) has given an undertaking to OT Australia to observe the standards set out in the document published by OT Australia titled ‘Australian Competency Standards for Occupational Therapists in Mental Health’, as in force on 1 November 2006. |
| 8. | Mental health serviceA person is an allied health professional in relation to the provision of a mental health service if the person meets one of the following requirements:(a) the person meets the requirements specified for an allied health professional in relation to the provision of an Aboriginal or Torres Strait Islander health service;(b) the person is:(i) in the case of a person who provides a mental health service in Tasmania or the Australian Capital Territory — registered as a mental health nurse under a law of Tasmania or the Australian Capital Territory, as the case requires; and(ii) in any other case — a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses;(c) the person is:(i) in the case of a person who provides a mental health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of OT Australia; and(ii) in the case of a person who is an occupational therapist and provides a mental health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;(d) the person is registered, without any limitation, with the Psychologist Registration Board established under the applicable law in force in the State or Territory in which the service is provided; |
| (e) the person is:(i) a Member of the Australian Association of Social Workers; and(ii) certified by that Association as meeting the standards for mental health set out in the document published by that Association titled ‘Competency Standards for Mental Health Social Workers 1999’, as in force on 1 November 2006. | |
| 9. | Non‑directive pregnancy support counselling health serviceA person is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service if the person meets one of the following requirements:(a) the person is certified by the Australian College of Mental Health Nurses:(i) as a credentialled mental health nurse; and(ii) as appropriately trained in non‑directive pregnancy counselling;(b) the person is registered, without any limitation, with the Psychologists Registration Board established under the applicable law in force in the State or Territory in which the service is provided and certified by the Australian Psychological Society as appropriately trained in non‑directive pregnancy counselling;(c) the person is:(i) a member of the Australian Association of Social Workers (AASW); and(ii) certified by AASW either as meeting the standards for mental health set out in the document published by that Association titled ‘Competency Standards for Mental Health Social Workers 1999’, as in force on 1 November 2006 or as an accredited social worker; and(iii) certified by AASW as appropriately trained in non‑directive pregnancy counselling.For this health service, a person is appropriately trained in non‑directive pregnancy counselling if the person has undergone training based on the key criteria contained in the document published by the Department titled ‘Key criteria for non‑directive pregnancy counselling training provided to GPs and allied health professionals in relation to the Medicare non‑directive pregnancy support counselling items’, as in force on 1 November 2006. |
| 10. | Occupational therapy health serviceA person is an allied health professional in relation to the provision of an occupational therapy health service if the person is:(a) in the case of a person who provides an occupational therapy health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of OT Australia; and(b) in the case of a person who provides an occupational therapy health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 11. | Osteopathy health serviceA person is an allied health professional in relation to the provision of an osteopathy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 12. | Physiotherapy health serviceA person is an allied health professional in relation to the provision of a physiotherapy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 13. | Podiatry health serviceA person is an allied health professional in relation to the provision of a podiatry health service if the person is:(a) in the case of a person who provides a podiatry health service in the Northern Territory:(i) a Full Member of the Australian Podiatry Association in a State or Territory other than the Northern Territory; or(ii) registered under a law of a State or Territory other than the Northern Territory to provide podiatry health services; and(b) in the case of a person who provides a podiatry health service in a State or Territory other than the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 14. | Psychological therapy health serviceA person is an allied health professional in relation to the provision of a psychological therapy health service if the person:(a) is registered, without any limitation, with the Psychologists Registration Board established under the applicable law in force in the State or Territory where the service is provided; and(b) either:(i) is a member of the Australian College of Clinical Psychologists of the Australian Psychological Society (APS); or(ii) has been assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements. |
| 15. | Psychology health serviceA person is an allied health professional in relation to the provision of a psychology health service if the person is registered, without any limitation, with the Psychologists Registration Board established under the applicable law in force in the State or Territory in which the service is provided. |
| 16. | Speech pathology health serviceA person is an allied health professional in relation to the provision of a speech pathology health service if the person is:(a) in the case of a person who provides a speech pathology health service in a State or Territory other than Queensland — a Practising Member of Speech Pathology Australia; and(b) in the case of a person who provides a speech pathology health service in Queensland — registered as a person who may provide that kind of service under the applicable law in force in Queensland. |
Schedule 2 Allied health services
(section 6)
Part 1 Services and fees — general
| Item | Service | Fee ($) |
|---|---|---|
| 10950 | Aboriginal or Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible Aboriginal health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | 56.25 |
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10951 | Diabetes education health service provided to a person by an eligible diabetes educator if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and | 56.25 |
| (c) the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | ||
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10952 | Audiology health service provided to a person by an eligible audiologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or | 56.25 |
| (ii) if the service is the first or last service under the referral — in relation to that service; or | ||
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | ||
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10953 | Exercise physiology health service provided to a person by an eligible exercise physiologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | 56.25 |
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10954 | Dietetics health service provided to a person by an eligible dietitian if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | 56.25 |
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10956 | Mental health service provided to a person by an eligible mental health worker if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | 56.25 |
| 10958 | Occupational therapy health service provided to a person by an eligible occupational therapist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | 56.25 |
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10960 | Physiotherapy health service provided to a person by an eligible physiotherapist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | 56.25 |
| 10962 | Podiatry health service provided to a person by an eligible podiatrist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and | 56.25 |
| (b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or | ||
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | ||
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10964 | Chiropractic health service provided to a person by an eligible chiropractor if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and | 56.25 |
| (g) after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | ||
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10966 | Osteopathy health service provided to a person by an eligible osteopath if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | 56.25 |
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10968 | Psychology health service provided to a person by an eligible psychologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and | 56.25 |
| (d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | ||
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 | ||
| 10970 | Speech pathology health service provided to a person by an eligible speech pathologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and | 56.25 |
| (b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and | ||
| (c) the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters; | ||
| to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 11 |
Part 2 Services and fees — psychological therapy and focussed psychological strategies
<table cellspacing="0" cellpadding="0" style="width:427.35pt; border-collapse:collapse"><thead><tr><td style="width:28.2pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableColHead" style="margin-top:3pt"><span>Item</span></p></td><td style="width:335.05pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableColHead" style="margin-top:3pt"><span>Service</span></p></td><td style="width:32pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableColHead" style="margin-top:3pt; text-align:right"><span>Fee ($)</span></p></td></tr></thead><tbody><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80000</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 30 minutes but less than 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>90.15</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80005</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item</span><span> </span><span>80000</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>112.60</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80010</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>132.25</span></p></td></tr><tr style="height:12.75pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span></span></p></td></tr><tr style="height:28.5pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p></td><td rowspan="2" style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span></span></p></td></tr><tr style="height:60.8pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80015</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80010</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>154.75</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80020</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Psychological therapy health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided in person; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 60 minutes duration;</span></p><p class="TableText" style="margin-top:6pt; margin-bottom:6pt"><span>to a maximum of 12 services (including services to which items</span><span> </span><span>80120, 80145 and 80170 apply) in a calendar year</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>33.60</span></p></td></tr><tr style="height:179.85pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80100</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p></td><td rowspan="2" style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>63.85</span></p></td></tr><tr style="height:23.05pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 20 minutes but less than 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80105</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80100</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>86.80</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80110</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>90.15</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80115</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80110</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>113.15</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80120</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible psychologist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>22.95</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP2i"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt; page-break-after:avoid"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided in person; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt; page-break-after:avoid"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 60 minutes duration;</span></p><p class="TableText" style="margin-top:6pt; margin-bottom:6pt; page-break-inside:avoid"><span>to a maximum of 12 services (including services to which items</span><span> </span><span>80120, 80145 and 80170 apply) in a calendar year</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span></span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80125</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 20 minutes but less than 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>56.25</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80130</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item</span><span> </span><span>80125</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>79.20</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80135</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>79.40</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span></span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80140</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item</span><span> </span><span>80135</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>102.35</span></p></td></tr><tr style="height:213pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80145</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible occupational therapist if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; font-size:12pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided in person; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 60 minutes duration;</span></p><p class="TableText" style="margin-top:6pt; margin-bottom:6pt"><span>to a maximum of 12 services (including services to which items</span><span> </span><span>80120, 80145 and 80170 apply) in a calendar year</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>20.20</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80150</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>56.25</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span></span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a" style="margin-bottom:6pt; page-break-after:avoid"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 20 minutes but less than 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span></span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80155</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80150</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>79.20</span></p></td></tr><tr style="height:219.4pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80160</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided to the person individually and in person; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 50 minutes duration</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>79.40</span></p></td></tr><tr><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80165</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80160</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 8, 9 and 11</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>102.35</span></p></td></tr><tr style="height:148.5pt"><td style="width:28.2pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>80170</span></p></td><td style="width:335.05pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span>Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible social worker if:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the person is referred by:</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or</span></p><p class="TableP2i" style="margin-top:3pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and</span></p></td><td style="width:32pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>20.20</span></p></td></tr><tr><td style="width:28.2pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableText"><span></span></p></td><td style="width:335.05pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableP1a"><span style="width:3.31pt; text-indent:0pt; display:inline-block"></span><span>(aa)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is provided in person; and</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the service is at least 60 minutes duration;</span></p><p class="TableText" style="margin-top:6pt; margin-bottom:6pt"><span>to a maximum of 12 services (including services to which items</span><span> </span><span>80120, 80145 and 80170 apply) in a calendar year</span></p><p class="TableText" style="margin-top:6pt"><span>This item is subject to sections 9 and 11</span></p></td><td style="width:32pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableColHead" style="margin-top:3pt; text-align:right"><span></span></p></td></tr></tbody></table> ```Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Health Insurance (Allied Health Services) Determination 2007
as amended
made under subsection 3C (1) of the
Health Insurance Act 1973
This compilation was prepared on 1 July 2008
taking into account amendments up to Health Insurance (Allied Health Services) Determination 2008 (No. 1)
Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra
Contents
1 Name of Determination [see Note 1]
2 Commencement
3 Revocation
4 Amendment of Health Insurance (Allied Health Services) Determination 2007
5 Interpretation
6 Treatment of allied health services
8 Limitation on certain items
9 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
10 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
11 Effect of election to claim private health insurance for an allied health service
Schedule 1 Qualification requirements for allied health professionals
Schedule 2 Allied health services
Part 1 Services and fees — general
Part 2 Services and fees — psychological therapy and focussed psychological strategies
Part 3 Services and fees — pregnancy support counselling
Part 4 Services and fees — group services
Division 4.1 Diabetes education services
Division 4.2 Exercise physiology services
Division 4.3 Dietetics services
Part 5 Services and fees — pervasive developmental disorder
Schedule 4 Amendments commencing on 1 January 2008
Notes
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Allied Health Services) Determination 2007.
2 Commencement
This Determination commences as follows:
(a) on 1 November 2007 — sections 1 to 3 and 5 to 9 and Schedules 1 to 3;
(b) on 1 January 2008 — section 4 and Schedule 4.
3 Revocation
The Health Insurance (Allied Health and Dental Services) Determination 2006 is revoked.
4 Amendment of Health Insurance (Allied Health Services) Determination 2007
Schedule 4 amends the Health Insurance (Allied Health Services) Determination 2007.
5 Interpretation
(1) In this Determination:
Act means the Health Insurance Act 1973.
allied health professional, in relation to the provision of an allied health service, means a person:
(a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and
(b) whose name is entered in the register, kept by the Medicare Australia CEO, of allied health professionals who are qualified to provide a service of that kind.
allied health service means a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975 that is specified in an item in Schedule 2.
course of treatment means:
(a) for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:
(i) an eligible clinical psychologist;
(ii) an eligible psychologist;
(iii) an eligible occupational therapist;
(iv) an eligible social worker; and
(b) for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
(i) an eligible psychologist;
(ii) an eligible speech pathologist;
(iii) an eligible occupational therapist.
eligible Aboriginal health worker means a person who is an allied health professional in relation to the provision of an Aboriginal or Torres Strait Islander health service.
eligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.
eligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.
eligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.
eligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.
eligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) an occupational therapy health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
enhanced primary care multidisciplinary care plan, for a patient, means:
(a) a multidisciplinary care plan for the patient, to which item 731 of the general medical services table applies; or
(b) a multidisciplinary community care plan for the patient, to which item 720 of a relevant repealed general medical services table applied; or
(c) a multidisciplinary discharge care plan for the patient, to which item 722 of a relevant repealed general medical services table applied; or
(d) a multidisciplinary care plan for the patient, to which item 730 of a relevant repealed general medical services table applied.
EPC plan, in relation to a patient, means:
(a) an enhanced primary care multidisciplinary care plan for the patient; or
(b) a care plan for the patient comprising:
(i) a GP management plan to which item 721 of the general medical services table applies; and
(ii) team care arrangements to which item 723 of the general medical services table applies.
focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑ based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy that involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy;
(f) narrative therapy (for Aboriginal and Torres Strait Islander people).
GP management plan, for a patient, means a GP management plan to which item 721 or 725 of the general medical services table applies.
GP Mental Health Care Plan, in relation to a patient, means a GP Mental Health Care Plan for the patient to which item 2710 of the general medical services table applies.
multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the general medical services table applies.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
OT Australia means the national body of the Australian Association of Occupational Therapists.
PDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.
relevant repealed general medical services table means the table prescribed by any of the following Regulations:
(a) the Health Insurance (1999–2000 General Medical Services Table) Regulations 1999 as in force immediately before 1 November 2000;
(b) the Health Insurance (General Medical Services Table) Regulations 2000 as in force immediately before 1 November 2001;
(c) the Health Insurance (General Medical Services Table) Regulations 2001 as in force immediately before 1 November 2002;
(d) the Health Insurance (General Medical Services Table) Regulations 2002 as in force immediately before 1 November 2003;
(e) the Health Insurance (General Medical Services Table) Regulations 2003 as in force immediately before 1 November 2004;
(f) the Health Insurance (General Medical Services Table) Regulations 2004 as in force immediately before 1 November 2005.
Note The following terms are defined in subsection 3 (1) of the Act:
Note: dental practitioner
Note: general medical services table
Note: medical practitioner
Note: Medicare Australia CEO
Note: professional service.
(2) A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a woman by a health professional in which:
(a) information and issues relating to pregnancy are discussed; but
(b) the health professional does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.
6 Treatment of allied health services
An allied health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
8 Limitation on certain items
(1) For any particular patient, an item mentioned in subsection (2) applies in a calendar year only if the service described in the item is:
(a) one of the first 12 relevant services provided to the patient in the calendar year; or
(b) if exceptional circumstances exist in relation to the patient — one of the first 18 relevant services provided to the patient in the calendar year.
(2) The items are items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.
(3) In this section:
exceptional circumstances exist in relation to a patient if:
(a) the patient has, in a calendar year, received at least 12 relevant services; and
(b) the patient’s referring medical practitioner is satisfied that there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for a service described in an item mentioned in paragraph (a) of the definition of relevant service.
relevant service means a service:
(a) to which any of items 2721 to 2727 of the general medical services table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply; or
(b) to which the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care Program applies.
9 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
(1) This section applies to items 80000 to 80170 in Schedule 2.
(2) The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral of a service to which any of items 293 to 370 of the general medical services table apply.
(3) The referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral of a service to which any of items 110 to 133 of the general medical services table apply.
(4) The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral of a service to which any of items 104 to 109 of the general medical services table apply.
10 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
(1) This section applies to items 82000 to 82025 in Schedule 2.
(2) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the general medical services table apply.
(3) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table apply.
(4) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the general medical services table applies.
(5) If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the general medical services table apply.
(6) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral to which item 135 of the general medical services table applies.
(7) If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the general medical services table apply.
11 Effect of election to claim private health insurance for an allied health service
An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.
Schedule 1 Qualification requirements for allied health professionals
(section 5)
| 1. | Aboriginal or Torres Strait Islander health serviceA person is an allied health professional in relation to the provision of an Aboriginal or Torres Strait Islander health service if:(a) in the case of a person who provides an Aboriginal or Torres Strait Islander health service in a State or Territory other than the Northern Territory — the person has been awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework; or(b) in the case of a person who provides an Aboriginal or Torres Strait Islander health service in the Northern Territory — the person is registered under the Health Practitioners Act (NT).
This is an opening excerpt, not the complete document.