Part Part 1 - Health Insurance (Allied Health Services) Determination 2009 - Services and fees — general

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: (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; 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 This item is subject to section 9 | 57.55 | | 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 | 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 (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 year This item is subject to section 9 | | | 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 (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; 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 This item is subject to section 9 | | | 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; 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 This item is subject to section 9 | 57.55 | | 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 | 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 (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; 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 This item is subject to section 9 | | | 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 | 57.55 | | | (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 year This item is subject to section 9 | | | 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; 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 This item is subject to section 9 | 57.55 | | 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 year This item is subject to section 9 | 57.55 | | 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 (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 | 57.55 | | | (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 year This item is subject to section 9 | | | 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 (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 year This item is subject to section 9 | 57.55 | | 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; 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 This item is subject to section 9 | 57.55 | | 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 (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 year This item is subject to section 9 | 57.55 | | 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 (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 year This item is subject to section 9 | 57.55 |

Part 1Services and fees — general

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