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Name of Determination
1 Name of Determination
This Determination is the Health Insurance (Allied Health Services) Determination 2011.
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Commonwealth legislation
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This Determination sets when Medicare will subsidise allied health care—services like psychology, physiotherapy, speech pathology, diabetes education and occupational therapy. It specifies who’s eligible (people with chronic disease, mental‑health plans, children with developmental disabilities, pregnant women seeking counselling, Aboriginal and Torres Strait Islander patients, people with type‑2 diabetes, and certain hearing tests), and the referral, provider‑registration, time and reporting requirements (including CPD for focussed psychological providers). It matters because it shapes access and affordability of outpatient allied health for millions of Australians.
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Direct links to the current provisions in Health Insurance (Allied Health Services) Determination 2011.
This Determination is the Health Insurance (Allied Health Services) Determination 2011.
This Determination commences on 1 July 2011.
The Health Insurance (Allied Health Services) Determination 2010 is revoked.
(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 Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind.
Note: Allied health professionals in relation to the provision of a focussed psychological strategies health service are subject to the requirements of section 10.
allied health service means:
(a) a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975; or
(b) a health service that is an optometry treatment service;
that is specified in an item in Schedule 2.
course of assessment means:
(a) for pervasive developmental disorder services—up to 4 services to which any of items 82000, 82005, 82010 or 82030 applies 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 audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist; or
(vii) an eligible speech pathologist; or
(b) for disability services—up to 4 services to which any of items 82000, 82005, 82010 or 82030 applies provided, on referral by a specialist or consultant physician practising in the practice of his or her field of specialty or a general practitioner, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist; or
(vii) an eligible speech pathologist.
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; or
(b) for pervasive developmental disorder services—up to 10 treatment services to which any of items 82015, 82020, 82025 and 82035 applies 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 audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist;
(vii) an eligible speech pathologist; or
(c) for disability services—up to 10 treatment services to which any of items 82015, 82020, 82025 and 82035 applies provided, on referral by a specialist or consultant physician specialising in the practice of his or her field of specialty, or a general practitioner, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist;
(vii) an eligible speech pathologist.
CPD year means the period of time in which focussed psychological strategies continuing professional development must be completed being:
(a) from the date of commencement of the Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 1) to 30 June 2011; and
(b) after 30 June 2011, 1 July to 30 June annually.
disability treatment and management plan for a child, means a plan for the treatment and management of the child’s eligible disability to which item 137 or 139 of the general medical services table applies.
eligible Aboriginal and Torres Strait Islander health practitioner means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 1 of item 1 of Schedule 1 of this Determination.
eligible Aboriginal health worker means a person who:
(a) is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 2 of item 1 of Schedule 1 of this Determination; and
(b) is not providing an Aboriginal and Torres Strait Islander health service in the Northern Territory.
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 disability means any of the following:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(c) deafblindness;
(d) cerebral palsy;
(e) Down syndrome;
(f) Fragile X syndrome;
(g) Prader‑Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith‑Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex, and
(ii) a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) an occupational therapy health service.
eligible optometrist means a person who is an allied health professional in relation to the provision of an optometry health service.
eligible orthoptist means a person who is an allied health professional in relation to the provision of an orthoptic health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
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).
focussed psychological strategies continuing professional development means the completion of 10 continuing professional development units per CPD year, each unit being 1 hour that relate to the delivery of focussed psychological strategies in any of the following areas:
(a) psycho‑education;
(b) cognitive‑behavioural therapy including;
(i) behavioural interventions;
(ii) behaviour modification;
(iii) exposure techniques;
(iv) activity scheduling;
(c) cognitive interventions including:
(i) cognitive therapy;
(d) relaxation strategies including;
(i) progressive muscle relaxation;
(ii) controlled breathing;
(e) skills training including;
(i) problem solving skills and training;
(ii) anger management;
(iii) social skills training;
(iv) communication training;
(v) stress management;
(vi) parent management training;
(f) interpersonal therapy;
(g) narrative therapy (for Aboriginal and Torres Strait Islander people);
(h) clinical skills to undertake a full assessment of a patient in order to form a diagnosis and commence treatment planning.
GP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the general medical services table applies.
GP Mental Health Treatment Plan, for a patient, means:
(a) a GP Mental Health Treatment Plan for the patient made before 1 November 2011 to which item 2702 or 2710 of the general medical services table as in force on 31 October 2011 applies; or
(b) a GP Mental Health Treatment Plan for the patient to which item 2700, 2701, 2715 or 2717 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.
National Law means:
(a) for a State or Territory other than Western Australia—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and
(b) for Western Australia—the legislation enacted by the Health Practitioner Regulation National Law(WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
Occupational Therapy Australia means the national body of the Australian Association of Occupational Therapists.
PDD treatment and management plan, for a child, means a plan for the treatment and management of the child’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies.
Psychology Board of Australia means that body established under section 31 of the National Law.
registered training organisation means a training provider registered under a law of a State, Territory or the Commonwealth to provide accredited vocational education and training.
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.
Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or item 732 of the general medical services table applies.
Note: The following terms are defined in subsection 3(1) of the Act:
dental practitioner
general medical services table
medical practitioner
Chief Executive Medicare
participating optometrist
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.
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.
(1) This section applies to items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2. (2) From 1 March 2012 until midnight 31 December 2012, for any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is: (a) one of the first 10 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 16 relevant services provided to the patient in the calendar year. (3) From 1 January 2013, for any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient in the calendar year. (4) In this section: (a) exceptional circumstances exist in relation to a patient if: (i) the patient has, in a calendar year, received at least 10 relevant services; and (ii) 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 the definition of relevant service; and (b) relevant service means a service 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.
(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 one of the first 10 services mentioned in items in subsection (2) provided to the patient in the calendar year. (2) The items are items 80020, 80120, 80145 and 80170 in Schedule 2.
(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 applies. (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 applies. (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 applies.
(1) This section applies to items 82000 to 82035 in Schedule 2. (2) For items 82000, 82005, 82010 and 82030 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 applies. (3) For items 82000, 82005, 82010 and 82030 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 applies. (4) For items 82015, 82020, 82025 and 82035 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 applies. (6) For items 82015, 82020, 82025 and 82035 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 applies. (8) If a child has previously been provided with a service mentioned in item 137 or 139, the medical practitioner cannot refer the child for a service to which item 135 or 289 of the general medical services table applies.
(1) This section applies to items 82000 to 82035 in Schedule 2. (2) For items 82000, 82005, 82010 and 82030 the referral by a specialist or consultant physician specialising in the practice of his or her field of speciality must be a referral for a service to which any of items 104 to 131 or 296 to 370 (except item 359) of the general medical services table apply. (3) For items 82000, 82005, 82010 and 82030 the referral by a general practitioner must be a referral for a service to which any of items 3 to 51 of the general medical services table applies. (4) For items 82015, 82020, 82025 and 82035 the referral by a specialist or consultant physician specialising in the practice of his or her field of speciality must be a referral for a service to which item 137 of the general medical services table applies. (5) For items 82015, 82020, 82025 and 82035 the referral by a general practitioner must be a referral for a service to which item 139 of the general medical services table applies. (6) If a child has previously been provided with a service mentioned in item 135 or 289, the medical practitioner cannot refer the child for a service to which item 137 or 139 of the general medical services table applies.
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.
(1) This section applies to items 82000, 82005, 82010 and 82030. (2) At the completion of a course of assessment, the allied health professional must provide a written report to the referring medical practitioner.
(1) To comply with this section a person must complete focussed psychological strategies continuing professional development each CPD year. (2) A person referred to in subsection (1) is required to keep written records of completion of focussed psychological strategies continuing professional development for a period of two years from the end of the CPD year to which the focussed psychological strategies continuing professional development relates. (3) For the period referred to in paragraph (a) of the meaning of CPD year in section 4(1), a person who is an allied health professional in relation to the provision of a focussed psychological strategies health service, as at the date of commencement of this Determination, may count for completion of focussed psychological strategies continuing professional development any of the units referred to within the meaning of that term in section 4(1) completed from 1 July 2009 to 30 June 2011. (4) Other than where subsection (7) applies, where a person seeks to become an allied health professional in relation to the provision of a focussed psychological strategies health service during a CPD year and meets the requirements set out in Schedule 1 for the provision of a focussed psychological strategies health service: (a) that person’s name will be entered on the register, kept by the Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind until the end of that CPD year; and (b) that person will have until the end of that CPD year to meet the focussed psychological strategies continuing professional development on a pro‑rata basis, with units being calculated from the first day of the month immediately succeeding the date of registration. (5) If the Minister is satisfied that an allied health professional in relation to the provision of a focussed psychological strategies health service has not completed their focussed psychological strategies continuing professional development, the Minister: (a) may decide to remove the name of that allied health professional from the register kept by the Chief Executive Medicare; and then (b) notify the Chief Executive Medicare to remove the name from the register. (6) Before the Minister provides notification under subsection (5)(b), the Minister must notify that allied health professional in writing of the decision setting out: (a) the decision; (b) the reasons for the decision; and (c) a statement of the allied health professional’s reconsideration rights under section 11. (7) If the name of a person has been removed from the register as an allied health professional in relation to the provision of a focussed psychological strategies health service under subsection (9) in order to become an allied health professional in relation to the provision of a focussed psychological strategies health service (reregistered) that person must apply to be registered and in his or her application must: (a) provide evidence of attaining the necessary amount of units that he or she was required to attain to comply with the focused psychological strategies continuing professional development in the CPD year in which he or she failed to comply; and if reregistered must (b) comply with subsection (1) as if the CPD year in which he or she was reregistered commenced on the date of reregistration. (8) The Minister may grant an exemption in whole or part from focussed psychological strategies continuing professional development, where: (a) a written application from an allied health professional has been received; and (b) the Minister is satisfied that special circumstances prevented the allied health professional from completing focussed psychological strategies continuing professional development in a CPD year. (9) Upon receiving notification under subsection (5)(b), the Chief Executive Medicare shall not remove the name of an allied health professional from the register until notified either: (a) under section 11(10) that if the allied health professional has applied under section 11(1), the Minister has given notice, under section 11(5) that the decision to remove has been affirmed; or (b) under section 11(10) that, if the allied health professional has applied under section 11(6), the Minister has given notice under section 11(9)(c); or (c) where subsections (9)(a) or (b) are not applicable that such period of time as referred to in section 11(2) has expired.
(1) Where the Minister has provided notification under section 10(6), the allied health professional may apply to the Minister for reconsideration of that decision. (2) The application must be made in writing: (a) within 28 days from the date of the decision; or (b) if the Minister is satisfied that special circumstances exist, within such further period as the Minister, before the expiration of the period referred to in paragraph (a), allows. (3) The allied health professional must set out the reasons for the application and in doing so, may provide new material for the Minister to consider. (4) The Minister must, within 28 days after receipt of an application made in accordance with subsection (1), reconsider the decision and make a new decision either: (a) affirming the decision; or (b) setting aside the decision. (5) The Minister must give the allied health professional notice in writing of the reconsideration decision setting out: (a) the decision; and (b) the reasons for the decision. (6) The allied health professional may, as an alternative to applying for reconsideration of the decision, request further time to complete the number of units required to satisfy the Minister that the allied health professional complies with section 10(1). (7) If the allied health professional makes a request for further time under subsection (6) that request takes the place of the right to reconsideration under subsection (1). (8) If the allied health professional makes a request under subsection (6), the period of time in which to complete the number of units required to satisfy the Minister is 28 days, commencing from the date of notification by the Minister that the allied health professional may complete the nominated amount of units. (9) If, by the end of the period of time referred to in subsection (8), the Minister is not satisfied that the allied health professional has completed the amount of units required to comply with section 10(1), the Minister must: (a) proceed as if the allied health professional had applied under subsection (1); (b) make a decision, which will be regarded as being made under subsection (4); and (c) give the allied health professional notice in writing of the decision as if the notice was given under subsection (5). (10) The Minister must provide a written copy of a decision made under this section to the Chief Executive Medicare.
(1) This section applies to items 82300 to 82332 in Schedule 2. (2) The request must be in writing and must contain: (a) the date of the request; and (b) the name of the eligible practitioner who requested the service and either the address of his or her place of practice or the provider number in respect of his or her place of practice; and (c) a description of the service which provides sufficient information to identify the service as relating to a particular item mentioned in subsection (1) but need not specify the item number. (3) A request may be for the performance of more than one diagnostic audiology service making up a single audiological assessment but cannot be for more than one audiological assessment.
| Item | Service | Fee($) |
|---|---|---|
| 10950 | Aboriginal and Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 or eligible Aboriginal and Torres Strait Islander health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of 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 or eligible Aboriginal and Torres Strait Islander health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral—in relation to that service; or(ii) if the service is the first or last service under the referral—in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | 62.25 |
| 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 | 62.25 |
| (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral—in relation to that service; or(ii) if the service is the first or last service under the referral—in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and | 62.25 |
| (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 | ||
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of 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 yearThis item is subject to section 9 | 62.25 |
| 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | 62.25 |
| (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 contains all the components of 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 yearThis 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | 62.25 |
| (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 contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and | ||
| (g) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral—in relation to that service; or(ii) if the service is the first or last service under the referral—in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of 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 | 62.25 |
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral—in relation to that service; or(ii) if the service is the first or last service under the referral—in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | 62.25 |
| 10962 | Podiatry health service provided to a person by an eligible podiatrist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements 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 | 62.25 |
| (b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and | ||
| (g) after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral—in relation to that service; or(ii) if the service is the first or last service under the referral—in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of 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 | 62.25 |
| (ii) if the service is the first or last service under the referral—in relation to that service; or | ||
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of 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 yearThis item is subject to section 9 | 62.25 |
| 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 | 62.25 |
| (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements 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 | ||
| (b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of 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 yearThis item is subject to section 9 | ||
| 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 both a GP Management Plan and Team Care Arrangements 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(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care 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 contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and | 62.25 |
| (e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral—in relation to that service; or | ||
| (ii) if the service is the first or last service under the referral—in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 |
| Item | Service | Fee($) |
|---|---|---|
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(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(d) the service is at least 30 minutes but less than 50 minutes durationThis item is subject to sections 6, 7 and 9 | 99.75 |
| 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 80000This item is subject to sections 6, 7 and 9 | 124.65 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 146.45 |
| (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(d) the service is at least 50 minutes durationThis 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 80010This item is subject to sections 6, 7 and 9 | 171.35 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and(b) the service is at least 60 minutes duration;This item is subject to sections 6A, 7 and 9 | 37.20 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 70.65 |
| (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 | ||
| (d) the service is at least 20 minutes but less than 50 minutes durationThis 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 80100This item is subject to sections 6, 7 and 9 | 96.15 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(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(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | 99.75 |
| 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 80110This item is subject to sections 6, 7 and 9 | 125.30 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and | 25.45 |
| (b) the service is at least 60 minutes duration;This item is subject to sections 6A, 7 and 9 | ||
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(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(d) the service is at least 20 minutes but less than 50 minutes durationThis item is subject to sections 6, 7 and 9 | 62.25 |
| 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 80125This item is subject to sections 6, 7 and 9 | 87.70 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 87.95 |
| (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(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | ||
| 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 80135This item is subject to sections 6, 7 and 9 | 113.35 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and(b) the service is at least 60 minutes duration;This item is subject to sections 6A, 7 and 9 | 22.35 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 62.25 |
| (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 | ||
| (d) the service is at least 20 minutes but less than 50 minutes durationThis 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 80150This item is subject to sections 6, 7 and 9 | 87.70 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(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(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | 87.95 |
| 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 80160This item is subject to sections 6, 7 and 9 | 113.35 |
| 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:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and(b) the service is at least 60 minutes duration;This item is subject to sections 6A, 7 and 9 | 22.35 |
| Item | Service | Fee($) |
|---|---|---|
| 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:(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(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and(ba) the service is provided to the woman individually and in person; and(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(d) the service is at least 30 minutes duration;to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancyThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriateThis item is subject to section 9[* in the general medical services table] | 73.15 |
| 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:(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(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and(ba) the service is provided to the woman individually and in person; and(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(d) the service is at least 30 minutes duration;to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancyThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriateThis item is subject to section 9[* in the general medical services table] | 73.15 |
| 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:(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(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and(ba) the service is provided to the woman individually and in person; and(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(d) the service is at least 30 minutes duration;to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancyThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriateThis item is subject to section 9[* in the general medical services table] | 73.15 |
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
This Determination is the Health Insurance (Allied Health Services) Determination 2011.
This Determination commences on 1 July 2011.
The Health Insurance (Allied Health Services) Determination 2010 is revoked.
(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 Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind.
Note: Allied health professionals in relation to the provision of a focussed psychological strategies health service are subject to the requirements of section 10.
allied health service means:
(a) a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975; or
(b) a health service that is an optometry treatment service;
that is specified in an item in Schedule 2.
course of assessment means:
(a) for pervasive developmental disorder services—up to 4 services to which any of items 82000, 82005, 82010 or 82030 applies 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 audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist; or
(vii) an eligible speech pathologist; or
(b) for disability services—up to 4 services to which any of items 82000, 82005, 82010 or 82030 applies provided, on referral by a specialist or consultant physician practising in the practice of his or her field of specialty or a general practitioner, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist; or
(vii) an eligible speech pathologist.
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; or
(b) for pervasive developmental disorder services—up to 10 treatment services to which any of items 82015, 82020, 82025 and 82035 applies 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 audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist;
(vii) an eligible speech pathologist; or
(c) for disability services—up to 10 treatment services to which any of items 82015, 82020, 82025 and 82035 applies provided, on referral by a specialist or consultant physician specialising in the practice of his or her field of specialty, or a general practitioner, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist;
(vii) an eligible speech pathologist.
CPD year means the period of time in which focussed psychological strategies continuing professional development must be completed being:
(a) from the date of commencement of the Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 1) to 30 June 2011; and
(b) after 30 June 2011, 1 July to 30 June annually.
disability treatment and management plan for a child, means a plan for the treatment and management of the child’s eligible disability to which item 137 or 139 of the general medical services table applies.
eligible Aboriginal and Torres Strait Islander health practitioner means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 1 of item 1 of Schedule 1 of this Determination.
eligible Aboriginal health worker means a person who:
(a) is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 2 of item 1 of Schedule 1 of this Determination; and
(b) is not providing an Aboriginal and Torres Strait Islander health service in the Northern Territory.
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 disability means any of the following:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(c) deafblindness;
(d) cerebral palsy;
(e) Down syndrome;
(f) Fragile X syndrome;
(g) Prader‑Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith‑Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex, and
(ii) a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) an occupational therapy health service.
eligible optometrist means a person who is an allied health professional in relation to the provision of an optometry health service.
eligible orthoptist means a person who is an allied health professional in relation to the provision of an orthoptic health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
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).
focussed psychological strategies continuing professional development means the completion of 10 continuing professional development units per CPD year, each unit being 1 hour that relate to the delivery of focussed psychological strategies in any of the following areas:
(a) psycho‑education;
(b) cognitive‑behavioural therapy including;
(i) behavioural interventions;
(ii) behaviour modification;
(iii) exposure techniques;
(iv) activity scheduling;
(c) cognitive interventions including:
(i) cognitive therapy;
(d) relaxation strategies including;
(i) progressive muscle relaxation;
(ii) controlled breathing;
(e) skills training including;
(i) problem solving skills and training;
(ii) anger management;
(iii) social skills training;
(iv) communication training;
(v) stress management;
(vi) parent management training;
(f) interpersonal therapy;
(g) narrative therapy (for Aboriginal and Torres Strait Islander people);
(h) clinical skills to undertake a full assessment of a patient in order to form a diagnosis and commence treatment planning.
GP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the general medical services table applies.
GP Mental Health Treatment Plan, for a patient, means:
(a) a GP Mental Health Treatment Plan for the patient made before 1 November 2011 to which item 2702 or 2710 of the general medical services table as in force on 31 October 2011 applies; or
(b) a GP Mental Health Treatment Plan for the patient to which item 2700, 2701, 2715 or 2717 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.
National Law means:
(a) for a State or Territory other than Western Australia—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and
(b) for Western Australia—the legislation enacted by the Health Practitioner Regulation National Law(WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
Occupational Therapy Australia means the national body of the Australian Association of Occupational Therapists.
PDD treatment and management plan, for a child, means a plan for the treatment and management of the child’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies.
Psychology Board of Australia means that body established under section 31 of the National Law.
registered training organisation means a training provider registered under a law of a State, Territory or the Commonwealth to provide accredited vocational education and training.
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.
Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or item 732 of the general medical services table applies.
Note: The following terms are defined in subsection 3(1) of the Act:
dental practitioner
general medical services table
medical practitioner
Chief Executive Medicare
participating optometrist
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.
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.
(1) This section applies to items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2. (2) From 1 March 2012 until midnight 31 December 2012, for any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is: (a) one of the first 10 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 16 relevant services provided to the patient in the calendar year. (3) From 1 January 2013, for any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient in the calendar year. (4) In this section: (a) exceptional circumstances exist in relation to a patient if: (i) the patient has, in a calendar year, received at least 10 relevant services; and (ii) 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 the definition of relevant service; and (b) relevant service means a service 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.
(1) For any particular patient, an item mentioned in subsection (
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