An item in Part 3 does not apply to a service provided in contravention of a law of the Commonwealth or of a State or Territory.
3 General
(1) In this table, unless the contrary intention appears:
ACRRM means the Australian College of Rural and Remote Medicine.
attendance of a minor nature or minor attendance, for an attendance on a patient by a consultant physician, means an attendance that:
(a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and
(b) does not result in a substantial alteration to the treatment of the patient.
closed reduction:
(a) means treatment of a dislocation or fracture by non‑operative reduction; and
(b) includes the use of percutaneous fixation, or external splintage by cast or splints.
comprehensive hyperbaric medicine facility means a separate hospital area that, on a 24-hour basis:
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) hyperbaric oxygen therapy at a treatment pressure
of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and
(ii) mechanical ventilation and invasive cardiovascular monitoring within a monoplace or multiplace chamber for the duration of the hyperbaric treatment; and
(b) is under the direction of at least 1 practitioner who is rostered, and immediately available, to the facility during normal working hours and who:
(i) is a specialist with training in diving and hyperbaric medicine; or
(ii) holds a Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society; and
(c) is staffed by:
(i) at least 1 medical practitioner with training in diving and hyperbaric medicine who is present in the facility and immediately available at all times when patients are being treated at the facility; and
(ii) at least 1 registered nurse with specific training in hyperbaric patient care to the published standards of the Hyperbaric Technicians and Nurses Association, who is present during hyperbaric oxygen therapy; and
(d) has admission and discharge policies in operation.
general intensive care unit means a separate hospital area that:
Part Part 2 - Health Insurance (General Medical Services Table) Regulations 2003 - Rules of interpretation | Zoe
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours — at least 1 specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and
(ii) at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day — at least 1 registered nurse; and
(c) has admission and discharge policies in operation.
general practitioner means:
(a) a practitioner who is vocationally registered under section 3F of the Act; or
(b) a practitioner who:
(i) is a Fellow of the RACGP; and
(ii) participates in the quality assurance and continuing medical education program of the RACGP; and
(iii) meets the RACGP requirements for quality assurance and continuing education; or
(c) a practitioner who is undertaking a placement in general practice that is approved by the RACGP:
(i) as part of a training program for general practice leading to the award of Fellowship of the RACGP; or
(ii) as part of another training program recognised by the RACGP as being of an equivalent standard; or
(iii) as part of the Rural and Remote Area Placement Program administered by the Australian College of Rural and Remote Medicine; or
(d) an eligible non-vocationally recognised medical practitioner; or
(e) a practitioner who is undertaking a placement in general practice as part of the Pre-vocational General Practice Placements Program administered by the ACRRM, RACGP or GPET.
GPET means the body registered under the Corporations Act 2001 as General Practice Education and Training Limited (ACN 095 433 140).
institution means a place (other than a hospital or residential aged care facility) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or intellectually disabled persons.
intensive care unit means a general intensive care unit or a neo-natal intensive care unit.
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 3; or
(ii) Part 3 of the diagnostic imaging services table; or
(iii) Part 3 of the pathology services table; and
(b) in a reference immediately followed by a number — the item so numbered.
A reference (if any) by number to item 55028 is a reference to the item so numbered in the diagnostic imaging services table.
neo-natal intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is capable of providing to a patient who is a newly born child:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours — at least 1 consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and
(ii) at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day — at least 1 registered nurse; and
(c) has admission and discharge policies in operation.
open reduction means treatment of a dislocation or fracture by either:
(a) operative exposure, including the use of any internal or external fixation; or
(b) non-operative (closed) reduction using intra-medullary fixation or external fixation.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner, for the referral of a patient, means:
(a) in the case of all referrals — a medical practitioner; and
(b) for a referral made to a specialist who is an ophthalmologist — an optometrist; and
(c) for a referral that arises out of a dental service provided by a dental practitioner and that is made to a specialist (but not a consultant physician) — a dental practitioner; and
(d) for a referral that arises out of a dental service provided by a dental practitioner who is approved by the Minister for the purposes of paragraph (b) of the definition of professional service in subsection 3 (1) of the Act and that is made to a consultant physician — a dental practitioner.
residential aged care facility means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.
Rural, Remote and Metropolitan Areas Classification means the document so titled, as in force on 1 January 2001, setting out certain categories of areas in Australia that have been determined by the Department by reference to population size and remoteness of locality on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994.
(2) A reference to a Group in the table includes every item in the Group, and a reference to a Subgroup in the table includes every item in the Subgroup.
(3) A reference in the table to an eligible non-vocationally recognised medical practitioner is a reference to:
(a) a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:
(i) is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and
(ii) is providing general medical services in accordance with that Program; or
(b) a medical practitioner who:
(i) is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and
(iii) is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:
(A) that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and
(B) of which the Commission has written notice; or
(c) a medical practitioner who:
(i) is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and
(iii) is not vocationally registered under section 3F of the Act; or
(d) a medical practitioner who:
(i) is registered as a medical practitioner under the Medical Deputising Service — After Hours Other Medical Practitioners Program; and
(iii) is not vocationally registered under section 3F of the Act.
(4) For subrule (3):
(a) the Rural Other Medical Practitioners’ Program is a program administered by the Commission that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and
(b) the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program is a program administered by the Department that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and
(c) the MedicarePlus for Other Medical Practitioners Program is a program administered by the Commission that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and
(d) the Medical Deputising Service — After Hours Other Medical Practitioners Program is a program administered by the Commission that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits.
4 Meaning of symbols (S) and (G)
(1) An item including the symbol (S) applies only to a service performed by a specialist (and not to a service performed by a consultant physician) in the practice of his or her specialty, being:
(a) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(b) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and
(iii) is provided within the period of validity of the referral that is applicable under regulation 31 of the Health Insurance Regulations 1975; or
(c) a service that:
(i) is provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(d) a service that:
(i) is provided to a patient who has not been referred to the specialist; and
(ii) is a service that, in an emergency within the meaning of subregulation 30 (5) of the Health Insurance Regulations 1975, the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.
(2) An item including the symbol (G) applies only to a service provided otherwise than by a specialist in accordance with subrule (1).
5 Meaning of single course of treatment in certain circumstances
(1) In subrules 3 (1), 4 (1) and 7 (1) and items 104, 105, 106, 107, 108, 110, 116, 119, 122, 128, 131, 385, 386, 387 and 388, single course of treatment, in relation to a patient, includes:
(a) the initial attendance on the patient by a specialist or consultant physician; and
(b) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(c) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or by the specialist or consultant physician.
(2) For subrule (1), single course of treatment does not include treatment of an unrelated illness that requires referral of the patient to the specialist’s or consultant physician’s care.
(3) For subrule (1), an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under regulation 31 of the Health Insurance Regulations 1975, initiates a new course of treatment if:
(a) the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and
(b) the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.