Health Insurance (Allied Health Services) Determination 2008

1 Name of Determination

  This Determination is the Health Insurance (Allied Health Services) Determination 2008.

2 Commencement

  This Determination commences on 1 November 2008.

3 Revocation

  The Health Insurance (Allied Health Services) Determination 2007 is revoked.

4 Interpretation

 (1) In this Determination:

Act means the Health Insurance Act 1973.

allied health professional, for 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, for 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, for 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:

 dental practitioner

 general medical services table

 medical practitioner

 Medicare Australia CEO

 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.

5 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.

6 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.

7 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 for 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 for 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 for a service to which any of items 104 to 109 of the general medical services table apply.

8 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 for a service 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.

9 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 4)

Do not delete : Schedule Part Placeholder

Schedule 2 Allied health services

(section 6)

Part 1 Services and fees — general

| 10950 | Aboriginal or Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10951 | Diabetes education health service provided to a person by an eligible diabetes educator if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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 | 57.55 | | | (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | | | 10952 | Audiology health service provided to a person by an eligible audiologist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or | 57.55 | | | (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;<br>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 year<br>This item is subject to section 9 | | | 10953 | Exercise physiology health service provided to a person by an eligible exercise physiologist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10954 | Dietetics health service provided to a person by an eligible dietitian if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> | 57.55 | | | (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | | | 10956 | Mental health service provided to a person by an eligible mental health worker if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and | 57.55 | | | (g) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | | | 10958 | Occupational therapy health service provided to a person by an eligible occupational therapist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10960 | Physiotherapy health service provided to a person by an eligible physiotherapist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10962 | Podiatry health service provided to a person by an eligible podiatrist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and | 57.55 | | | (g) after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | | | 10964 | Chiropractic health service provided to a person by an eligible chiropractor if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10966 | Osteopathy health service provided to a person by an eligible osteopath if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10968 | Psychology health service provided to a person by an eligible psychologist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 | | 10970 | Speech pathology health service provided to a person by an eligible speech pathologist if:<br> (a) the service is provided to a person who has:<br> (i) a chronic condition; and<br> (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<br> (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<br> (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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 20 minutes duration; and<br> (g) after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or last service under the referral — in relation to that service; or<br> (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;<br>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 year<br>This item is subject to section 9 | 57.55 |

Part 2 Services and fees — psychological therapy and focussed psychological strategies

| 80000 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br> (c) 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<br> (d) the service is at least 30 minutes but less than 50 minutes duration<br>This item is subject to sections 7, 8 and 9 | 92.20 | | 80005 | 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 80000<br>This item is subject to sections 6, 7 and 9 | 115.20 | | 80010 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 135.30 | | | (c) 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<br> (d) the service is at least 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | | | 80015 | 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<br>This item is subject to sections 6, 7 and 9 | 158.30 | | 80020 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided in person; and<br> (b) the service is at least 60 minutes duration;<br>to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year<br>This item is subject to sections 7 and 9 | 34.35 | | 80100 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 65.30 | | | (c) 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<br> (d) the service is at least 20 minutes but less than 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | | | 80105 | 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<br>This item is subject to sections 6, 7 and 9 | 88.80 | | 80110 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br> (c) 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<br> (d) the service is at least 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | 92.20 | | 80115 | 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<br>This item is subject to sections 6, 7 and 9 | 115.75 | | 80120 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided in person; and<br> (b) the service is at least 60 minutes duration;<br>to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year<br>This item is subject to sections 7 and 9 | 23.50 | | 80125 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br> (c) 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<br> (d) the service is at least 20 minutes but less than 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | 57.55 | | 80130 | 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 80125<br>This item is subject to sections 6, 7 and 9 | 81.00 | | 80135 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br> (c) 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<br> (d) the service is at least 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | 81.25 | | 80140 | 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 80135<br>This item is subject to sections 6, 7 and 9 | 104.70 | | 80145 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided in person; and<br> (b) the service is at least 60 minutes duration;<br>to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year<br>This item is subject to sections 7 and 9 | 20.65 | | 80150 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 57.55 | | | (c) 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<br> (d) the service is at least 20 minutes but less than 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | | | 80155 | 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<br>This item is subject to sections 6, 7 and 9 | 81.00 | | 80160 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided to the person individually and in person; and<br> (b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br> (c) 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<br> (d) the service is at least 50 minutes duration<br>This item is subject to sections 6, 7 and 9 | 81.25 | | 80165 | 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<br>This item is subject to sections 6, 7 and 9 | 104.70 | | 80170 | 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:<br> (a) the person is referred by:<br> (i) a medical practitioner, either as part of a GP Mental Health Care Plan or as part of a psychiatrist assessment and management plan; or<br> (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br> (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br> (aa) the service is provided in person; and<br> (b) the service is at least 60 minutes duration;<br>to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar year<br>This item is subject to sections 7 and 9 | 20.65 |

Part 3 Services and fees — pregnancy support counselling

| 81000 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible psychologist if:<br> (a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and<br> (b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and<br> (ba) the service is provided to the woman individually and in person; and<br> (c) the eligible psychologist does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and<br> (d) the service is at least 30 minutes duration;<br>to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy<br>The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate<br>This item is subject to section 9<br>[* in the general medical services table] | 67.60 | | 81005 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible social worker if:<br> (a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and<br> (b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and<br> (ba) the service is provided to the woman individually and in person; and<br> (c) the eligible social worker does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and<br> (d) the service is at least 30 minutes duration;<br>to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy<br>The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate<br>This item is subject to section 9<br>[* in the general medical services table] | 67.60 | | 81010 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible mental health nurse if:<br> (a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and<br> (b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and<br> (ba) the service is provided to the woman individually and in person; and<br> (c) the eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and<br> (d) the service is at least 30 minutes duration;<br>to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancy<br>The service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate<br>This item is subject to section 9<br>[* in the general medical services table] | 67.60 |

Part 4 Services and fees — group services

Division 4.1 Diabetes education services

| 81100 | Diabetes education health service provided to a person by an eligible diabetes educator for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:<br> (a) the person has type 2 diabetes; and<br> (b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and<br> (c) the person is referred to an 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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 45 minutes duration; and<br> (g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c);<br>payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)<br>This item is subject to section 9 | 73.75 | | 81105 | Diabetes education health service provided to a person by an eligible diabetes educator, as a group service for the management of type 2 diabetes if:<br> (a) the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and<br> (b) the service is provided to a person who is part of a group of between 2 and 12 patients; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided in person; and<br> (e) the service is of at least 60 minutes duration; and | 18.40 | | | (f) after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner; and<br> (g) an attendance record for the group is maintained by the eligible diabetes educator;<br>to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)<br>This item is subject to section 9 | |

Division 4.2 Exercise physiology services

| 81110 | Exercise physiology health service provided to a person by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:<br> (a) the person has type 2 diabetes; and<br> (b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and<br> (c) the person is referred to an 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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and<br> (f) the service is of at least 45 minutes duration; and<br> (g) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c);<br>payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)<br>This item is subject to section 9 | 73.75 | | 81115 | Exercise physiology health service provided to a person by an eligible exercise physiologist, as a group service for the management of type 2 diabetes if:<br> (a) the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and<br> (b) the service is provided to a person who is part of a group of between 2 and 12 patients; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided in person; and<br> (e) the service is of at least 60 minutes duration; and<br> (f) after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contributes to, a written report to be provided to the referring medical practitioner; and<br> (g) an attendance record for the group is maintained by the eligible exercise physiologist;<br>to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)<br>This item is subject to section 9 | 18.40 |

Division 4.3 Dietetics services

| 81120 | Dietetics health service provided to a person by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:<br> (a) the person has type 2 diabetes; and<br> (b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and<br> (c) the person is referred to an 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<br> (d) the person is not an admitted patient of a hospital; and<br> (e) the service is provided to the person individually and in person; and | 73.75 | | | (f) the service is of at least 45 minutes duration; and<br> (g) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);<br>payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)<br>This item is subject to section 9 | | | 81125 | Dietetics health service provided to a person by an eligible dietitian, as a group service for the management of type 2 diabetes if:<br> (a) the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and<br> (b) the service is provided to a person who is part of a group of between 2 and 12 patients; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided in person; and<br> (e) the service is of at least 60 minutes duration; and<br> (f) after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and<br> (g) an attendance record for the group is maintained by the eligible dietitian;<br>to a maximum of 8 group services in a calendar year (including services to which items 81105, 81115 and 81125 apply)<br>This item is subject to section 9 | 18.40 |

Part 5 Services and fees — pervasive developmental disorder

| 82000 | Psychology health service provided to a child aged under 13 years by an eligible psychologist if:<br> (a) the child was referred to the eligible psychologist by an eligible practitioner:<br> (i) to assist with the diagnosis of the child by the practitioner; or<br> (ii) to contribute to the child’s PDD treatment and management plan; and<br> (b) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and<br> (c) the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and<br> (d) the child is not an admitted patient of a hospital; and<br> (e) the service is provided to the child individually and in person; and<br> (f) the service is at least 50 minutes duration;<br>to a maximum of 4 services (including services to which this item or items 82005 and 82010 apply)<br>This item is subject to sections 8 and 9 | 92.20 | | 82005 | Speech pathology health service provided to a child aged under 13 years by an eligible speech pathologist if:<br> (a) the child was referred to the eligible speech pathologist by an eligible practitioner:<br> (i) to assist with the diagnosis of the child by the practitioner: or<br> (ii) to contribute to the child’s PDD treatment and management plan; and<br> (b) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and<br> (c) the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and<br> (d) the child is not an admitted patient of a hospital; and<br> (e) the service is provided to the child individually and in person; and<br> (f) the service is at least 50 minutes duration;<br>to a maximum of 4 services (including services to which this item or items 82000 and 82010 apply)<br>This item is subject to sections 8 and 9 | 81.25 | | 82010 | Occupational therapy health service provided to a child aged under 13 years by an eligible occupational therapist if:<br> (a) the child was referred to the eligible occupational therapist by an eligible practitioner:<br> (i) to assist with the diagnosis of the child by the practitioner: or<br> (ii) to contribute to the child’s PDD treatment and management plan; and<br> (b) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and<br> (c) the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and<br> (d) the child is not an admitted patient of a hospital; and<br> (e) the service is provided to the child individually and in person; and<br> (f) the service is at least 50 minutes duration;<br>to a maximum of 4 services (including services to which this item or items 82000 and 82005 apply)<br>This item is subject to sections 8 and 9 | 81.25 | | 82015 | Psychology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible psychologist, if:<br> (a) the child has been diagnosed with a PDD; and<br> (b) the child, while aged under 13 years, received a PDD treatment and management plan; and<br> (c) the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and<br> (d) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and<br> (e) the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and<br> (f) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and<br> (g) the child is not an admitted patient of a hospital; and<br> (h) the service is provided to the child individually and in person; and<br> (i) the service is at least 30 minutes duration;<br>to a maximum of 20 services (including services to which this item or items 82020 and 82025 apply)<br>This item is subject to sections 8 and 9 | 92.20 | | 82020 | Speech pathology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible speech pathologist, if:<br> (a) the child has been diagnosed with a PDD; and<br> (b) the child, while aged under 13 years, received a PDD treatment and management plan; and<br> (c) the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and<br> (d) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and<br> (e) the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and<br> (f) on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and<br> (g) the child is not an admitted patient of a hospital; and<br> (h) the service is provided to the child individually and in person; and<br> (i) the service is at least 30 minutes duration;<br>to a maximum of 20 services (including services to which this item or items 82015 and 82025 apply)<br>This item is subject to sections 8 and 9 | 81.25 | | 82025 | Occupational therapy health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible occupational therapist if:<br> (a) the child has been diagnosed with a PDD; and<br> (b) the child, while aged under 13 years, received a PDD treatment and management plan; and<br> (c) the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and<br> (d) the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and<br> (e) the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and<br> (f) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and | 81.25 | | | (g) the child is not an admitted patient of a hospital; and<br> (h) the service is provided to the child individually and in person; and<br> (i) the service is at least 30 minutes duration;<br>to a maximum of 20 services (including services to which this item or items 82015 and 82020 apply)<br>This item is subject to sections 8 and 9 | |

Part 6 Services and fees — Aboriginal and Torres Strait Islander services

| 81300 | Aboriginal or Torres Strait Islander health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible Aboriginal health worker if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible Aboriginal health worker by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81305 | Diabetes education health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible diabetes educator if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible diabetes educator by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and | 57.55 | | | (f) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | | | 81310 | Audiology health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible audiologist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible audiologist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81315 | Exercise physiology health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible exercise physiologist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible exercise physiologist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81320 | Dietetics health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible dietitian if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible dietitian by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81325 | Mental health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible mental health worker if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible mental health worker by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81330 | Occupational therapy health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible occupational therapist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible occupational therapist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and | 57.55 | | | (f) after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | | | 81335 | Physiotherapy health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible physiotherapist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible physiotherapist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81340 | Podiatry health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible podiatrist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible podiatrist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81345 | Chiropractic health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible chiropractor if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible chiropractor by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81350 | Osteopathy health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible osteopath if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible osteopath by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81355 | Psychology health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible psychologist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible psychologist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 | | 81360 | Speech pathology health service provided to a person of Aboriginal or Torres Strait Islander descent by an eligible speech pathologist if:<br> (a) a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and<br> (b) the person is referred to the eligible speech pathologist by a medical practitioner using a referral form issued by the Department or a referral form that substantially complies with the form issued by the Department; and<br> (c) the person is not an admitted patient of a hospital; and<br> (d) the service is provided to the person individually and in person; and<br> (e) the service is of at least 20 minutes duration; and<br> (f) after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (b):<br> (i) if the service is the only service under the referral — in relation to that service; or<br> (ii) if the service is the first or the last service under the referral – in relation to that service; or<br> (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;<br>to a maximum of 5 services (including any services to which this item or any other item in Part 6 of this Schedule applies) in a calendar year<br>This item is subject to section 9 | 57.55 |

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See http://www.frli.gov.au.