6Limitation on certain items

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 e 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.