Health Insurance (General Medical Services Table) Regulations 2006

49A Meaning of GP management plan

(1) For item 721, preparation of a GP management plan means the preparation of a comprehensive written plan describing all of the following matters:

(a) the patient’s health care needs, health problems and relevant conditions;

(b) management goals with which the patient agrees;

(c) actions to be taken by the patient;

(d) treatment and services the patient is likely to need;

(e) arrangements for providing the treatment and services referred to in paragraph (d);

(f) arrangements to review the plan by a day specified in the plan.

(2) Preparation of the plan also includes:

(a) explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and

(b) recording the plan; and

(c) recording the patient’s agreement to the preparation of the plan; and

(d) offering a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(e) adding a copy of the plan to the patient’s medical records.

51 Meaning of multidisciplinary discharge care plan

For items 725 and 727, a multidisciplinary discharge care plan is a multidisciplinary care plan that is prepared for a patient before the patient is discharged from a hospital.

51A Meaning of team care arrangements

(1) For item 723, co‑ordinating the development of team care arrangements means a process by which the medical practitioner:

(a) in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner — makes arrangements for the multidisciplinary care of the patient; and

(b) prepares a document that describes all of the matters specified in subrule (2); and

(c) undertakes all of the activities specified in subrule (3).

(2) The matters to be described for paragraph (1) (b) are:

(a) treatment and service goals for the patient; and

(b) treatment and services that collaborating providers will provide to the patient; and

(c) actions to be taken by the patient; and

(d) arrangements to review the matters mentioned in paragraphs (a), (b) and (c) by a day specified in the document.

(3) The activities to be undertaken for paragraph (1) (c) are:

(a) explaining the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(b) discussing with the patient the collaborating providers who will contribute to the development of the team care arrangements, and provide treatment and services to the patient under those arrangements; and

(c) recording the patient’s agreement to the development of team care arrangements; and

(d) giving copies of the relevant parts of the document to the collaborating providers; and

(e) offering a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(f) adding a copy of the document to the patient’s medical records.

(4) In this rule:

collaborating provider is a person who:

(a) provides treatment or a service to a patient; and

(b) is not a family carer of the patient.

51B Meaning of associated medical practitioner

(1) For item 725 and item 727, an associated medical practitioner is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.

52A Meaning of review of plans

(1) For item 725, review of a GP management plan, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner:

(a) reviews the matters mentioned in subrule 49 (1) of the 2004 General Medical Services Table or subrule 49A (1), as applicable; and

(b) if different arrangements need to be made, makes amendments to the plan that:

(i) state those new arrangements; and

(ii) provide for further review of the amended plan by a date specified in the plan.

(2) Review of the plan also includes:

(a) explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review; and

(b) recording the patient’s agreement to the review of the plan; and

(c) if amendments are made to the plan:

(i) offering a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(ii) adding a copy of the amended plan to the patient’s medical records.

53A Meaning of co‑ordinate a review of team care arrangements or of a multidisciplinary care plan

(1) For item 727, to co‑ordinate a review of team care arrangements, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner:

(a) in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner, reviews the matters mentioned in subrule 49 (1) of the 2004 General Medical Services Table or subrule 51A (2), as applicable; and

(b) if different arrangements need to be made, makes amendments to the document mentioned in paragraph 51A (1) (b), or to the plan, that:

(i) state those new arrangements; and

(ii) provide for the review of the amended document or plan by a date specified in the document or plan.

(2) Co‑ordinating a review of team care arrangements or of a multidisciplinary care plan also includes:

(a) explaining the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(b) recording the patient’s agreement to the review of the team care arrangements or the plan; and

(c) giving copies of the relevant parts of the amended document mentioned in paragraph (1) (b), or the amended plan, to the collaborating providers; and

(d) offering a copy of the amended document or plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

(e) adding a copy of the amended document or plan to the patient’s medical records.

(3) In this rule:

collaborating provider is a person who:

(a) provides treatment or a service to a patient; and

(b) is not a family carer of the patient.

53B Meaning of contribute to a multidisciplinary care plan for items 729 and 731

(1) For items 729 and 731, to contribute to a multidisciplinary care plan or to the review of a plan includes:

(a) preparing part of the plan or amendments to the plan, and adding a copy of that part or those amendments to the patient’s medical records; or

(b) giving advice to a person who prepares or reviews the plan, and recording in writing, on the patient’s medical records, any advice provided to such a person.

multidisciplinary care plan means a written plan that:

(a) is prepared for a patient by:

(i) a medical practitioner, in consultation with 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and 1 of whom may be another medical practitioner; or

(ii) a collaborating provider (other than a medical practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and

(b) describes, at least, treatment and services to be provided to the patient by the collaborating providers.

(3) In this rule:

collaborating provider:

(a) is a person who:

(i) provides treatment or a service to a patient; and

(ii) is not a family carer of the patient; and

(b) includes a medical practitioner.

54 Meaning of multidisciplinary case conference

For the items mentioned in Subgroup 2 of Group A15, a multidisciplinary case conference is a process by which a multidisciplinary case conference team (see rule 57) carries out all of the following activities:

(a) discussing a patient’s history;

(b) identifying the patient’s multidisciplinary care needs;

(c) identifying outcomes to be achieved by members of the case conference team giving care and service to the patient;

(d) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;

(e) assessing whether previously identified outcomes (if any) have been achieved.

55 Meaning of multidisciplinary discharge case conference

For items 746, 749, 757, 768, 771 and 773, a multidisciplinary discharge case conference is a multidisciplinary case conference carried out in relation to a patient before the patient is discharged from a hospital.

56 Meaning of multidisciplinary case conference in a residential aged care facility

For items 734, 736, 738, 775, 778 and 779, a multidisciplinary case conference in a residential aged care facility is a multidisciplinary case conference carried out in relation to a care recipient in a residential aged care facility.

57 Meaning of multidisciplinary case conference team

(1) For this table, a multidisciplinary case conference team:

(a) includes a medical practitioner; and

(b) includes at least 2 other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and 1 of whom may be another medical practitioner; and

(c) may additionally include a family carer of the patient.

Example

Examples of persons who, for paragraph (b), may be included in a team are:

Note: (a) allied health professionals such as:

 Aboriginal health care workers

 asthma educators

 audiologists

 dental therapists

 dentists

 diabetes educators

 dieticians

 mental health workers

 occupational therapists

 optometrists

 orthoptists

 orthotists or prosthetists

 pharmacists

 physiotherapists

 podiatrists

 psychologists

 registered nurses

 social workers

 speech pathologists; and

Note: (b) home and community service providers, or care organisers, such as:

 education providers

 ‘meals on wheels’ providers

 personal care workers

 probation officers.

58 Meaning of organise and co‑ordinate in a multidisciplinary case conference and participation in a multidisciplinary case conference

(1) For items 734, 736, 738, 740, 742, 744, 746, 749 and 757, organise and co‑ordinate a multidisciplinary case conference means undertaking all of the following activities in relation to a case conference:

(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the conference taking place;

(b) recording the patient’s agreement to the conference;

(c) recording the day on which the conference was held, and the times at which the conference started and ended;

(d) recording the names of the participants;

(e) recording the matters mentioned in rule 54, and putting a copy of that record in the patient’s medical records;

(f) offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

(g) discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

(2) For items 759, 762, 765, 768, 771, 773, 775, 778 and 779, participation in a multidisciplinary case conference must be at the request of the person who organises and co‑ordinates the conference, and involves undertaking all of the following activities in relation to a case conference:

(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the practitioner’s participation in the conference;

(b) recording the patient’s agreement to the practitioner’s participation;

(c) recording the day on which the conference was held, and the times at which the conference started and ended;

(d) recording the names of the participants;

(e) recording the matters mentioned in rule 54, and putting a copy of that record in the patient’s medical records.

(3) Participation in a multidisciplinary case conference does not include organising and co‑ordinating a multidisciplinary case conference.

58A Meaning of co‑ordinate in item 880

For item 880, co‑ordinating a case conference means undertaking all of the following activities in relation to a case conference:

(a) co‑ordinating and facilitating the case conference;

(b) resolving any disagreement or conflict to enable the members of the case conference team giving care and service to the patient to agree on the outcomes to be achieved;

(c) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;

(d) recording the input of each member and the outcome of the conference.

58B Meaning of case conference team in item 880

(1) For item 880, a case conference team:

(a) includes a specialist, or consultant physician, in the practice of his or her specialty of geriatric or rehabilitation medicine; and

(b) includes at least 2 other allied health professionals, each of whom provides a different kind of care or service to the patient and is not a medical practitioner or family carer of the patient; and

(c) may include the patient, a family carer of the patient or a medical practitioner.

Example

Examples of persons who, for paragraph (b), may be included in a team are:

Note:  dieticians

Note:  mental health workers

Note:  occupational therapists

Note:  pharmacists

Note:  physiotherapists

Note:  podiatrists

Note:  psychologists

Note:  social workers

Note:  speech pathologists.

58C Application of item 880

(1) Item 880 applies only if:

(a) the attendance is by a specialist, or consultant physician, in the specialty of geriatric medicine or rehabilitation medicine for the purposes of the Act; and

(b) the attendance is on a patient who:

(i) is an admitted patient of a hospital; and

(ii) is not a care recipient in a residential aged care facility; and

(iii) is being provided with 1 of the following types of specialist care:

(A) geriatric evaluation and management;

(B) rehabilitation care.

(2) In this rule:

geriatric evaluation and management means care provided to a patient with a disability or psychosocial problem for the purpose of maximising the patient’s health status or optimising the patient’s living arrangements.

rehabilitation care means care provided to a patient with an impairment or disability for the purpose of improving the patient’s functional status.

59 Meaning of living in a community setting in item 900

For item 900, a patient is living in a community setting if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility.

60 Meaning of residential medication management review in item 903

(1) For item 903, a residential medication management review is a collaborative service provided by a medical practitioner and a pharmacist to review the medication management needs of a permanent resident of a residential aged care facility.

(2) A medical practitioner’s involvement in a residential medication management review includes all of the following:

(a) discussing the proposed review with the resident and seeking the resident’s consent to the review;

(b) collaborating with the reviewing pharmacist about the pharmacist’s involvement in the review;

(c) providing input from the resident’s most recent comprehensive medical assessment or, if such an assessment has not been undertaken, providing relevant clinical information for the review and for the resident’s records;

(d) subject to subrule (4), participating in a post‑review discussion (either face‑to‑face or by telephone) with the pharmacist to discuss the outcomes of the review including:

(i) the findings of the review; and

(ii) medication management strategies; and

(iii) means to ensure that the strategies are implemented and reviewed, including any issues for implementation and follow‑up;

(e) developing or revising the resident’s medication management plan after discussion with the reviewing pharmacist, and finalising the plan after discussion with the resident.

(3) A medical practitioner’s involvement in a residential medication management review also includes:

(a) offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate); and

(b) providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and

(c) discussing the plan with nursing staff if necessary.

(4) A post‑review discussion is not required if:

(a) there are no recommended changes to the resident’s medication management arising out of the review; or

(b) any changes are minor in nature and do not require immediate discussion; or

(c) the pharmacist and medical practitioner agree that issues arising out of the review should be considered in an enhanced primary care case conference.

61 Meaning of amount under rule 61 in certain items

(1) In item 2503, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2501; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(2) In item 2506, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2504; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(3) In item 2509, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2507; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(4) In item 2518, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2517; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(5) In item 2522, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2521; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(6) In item 2526, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2525; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(7) In item 2547, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2546; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(8) In item 2553, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2552; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(9) In item 2559, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2558; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(10) In item 2575, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2574; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(11) In item 2578, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2577; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(12) In item 2723, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2721; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

(13) In item 2727, amount under rule 61 means an amount equal to the sum of:

(a) the fee for item 2725; and

(i) if not more than 6 patients are attended at a single attendance — $22.45 divided by the number of patients attended; or

62 Application of Subgroup 2 of Group A18 and Subgroup 2 of Group A19

(1) An item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19 does not apply to a service that is provided to a patient who has already been provided, in the previous 11 months, with another service to which an item in either of those Subgroups applies.

(2) For an item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19, a professional attendance completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus if the attendance completes a series of attendances that involve, over a period of at least 11 months and up to 13 months, (the current cycle), the following:

(a) at least 1 assessment of the patient’s diabetes control, by measuring the patient’s HbA1c;

(b) subject to subrule (3), if the patient has not had a comprehensive eye examination in the cycle of care ending immediately before the current cycle — at least 1 comprehensive eye examination;

(c) measurement of the patient’s weight and height, and calculation of the patient’s BMI;

(d) 2 further measurements of the patient’s weight with each measurement being taken at least 5 months after the previous measurement;

(e) 2 measurements of the patient’s blood pressure, taken at least 5 months but not more than 7 months apart;

(f) subject to subrule (3), 2 examinations of the patient’s feet, carried out at least 5 months but not more than 7 months apart;

(g) at least 1 measurement of the patient’s total cholesterol, triglycerides and HDL cholesterol;

(h) at least 1 test of the patient’s microalbuminuria;

(i) provision to the patient of self‑management education regarding diabetes;

(j) a review of the patient’s diet, and provision to the patient of information about appropriate dietary choices;

(k) a review of the patient’s level of physical activity, and provision to the patient of information about the appropriate level of physical activity;

(l) checking the patient’s tobacco smoking activity, and, if relevant, encouraging the patient to stop smoking;

(m) a review of the patient’s medication.

(3) For a patient with established diabetes mellitus who is mentioned in the following table, the minimum requirements of a cycle of care for the patient in relation to paragraphs (2) (b) and (f) may be completed as set out in the table.

63 Application of Subgroup 3 of Group A18 and Subgroup 3 of Group A19

(1) An item in Subgroup 3 of Group A18 or Subgroup 3 of Group A19 does not apply to a service that:

(a) is provided to a patient who has already been provided, in the previous 12 months, with another service to which an item in either of those Subgroups applies; and

(b) is not clinically indicated.

(2) For an item in Subgroup 3 of Group A18 or Subgroup 3 of Group A19, a professional attendance completes the minimum requirements of the Asthma Cycle of Care if the attendance completes a series of attendances that involve:

(a) documented diagnosis and documented assessment of level of asthma control and severity of asthma; and

(b) at least 2 asthma‑related consultations within 12 months (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation and includes the review mentioned in subparagraph (iv)) that involve the following for a patient with moderate to severe asthma:

(i) a review of the patient’s use of and access to asthma related medication and devices;

(ii) either:

(A) provision to the patient of a written asthma action plan; or

(B) if the patient is unable to use a written asthma action plan — discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient’s medical records;

(iii) provision of asthma self‑management education to the patient;

(iv) at the review consultation:

(A) a review of the patient’s written or documented asthma action plan; and

(B) if necessary, adjustment of that plan.

63A Application of Group A24

(1) Subgroups 1 and 2 of Group A24 apply only if the attendance is by a medical practitioner who is recognised as a specialist, or consultant physician, in the specialty of pain medicine for the purposes of the Act.

(2) Subgroups 3 and 4 of Group A24 apply only if the attendance is by a medical practitioner who is recognised as a specialist, or consultant physician, in the specialty of palliative medicine for the purposes of the Act.

63AA Meaning of outer metropolitan area and outer metropolitan specialist trainee in items 5906, 5908, 5910 and 5912

In items 5906, 5908, 5910 and 5912:

outer metropolitan area means an area in Australia that has been determined by the Department by reference to a locality that lies outside the urban centre area of a capital city (on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994).

outer metropolitan specialist trainee means:

(a) a medical practitioner who is currently enrolled in and undertaking a training course in an approved specialist college listed as a specified body in Schedule 5 to the Health Insurance Regulations 1975 (excluding the Royal Australian College of General Practitioners); or

(b) a practitioner who is undertaking a placement as part of the structured training program of the approved specialist college that provides experience not available in teaching hospitals:

(i) as part of an accredited ‘advanced’ training placement, or a training placement approved by the Department, that fully counts towards training time and other formal requirements; and

(ii) as a college trainee with access to medicare benefits that is limited to attendances provided at a practice nominated by the approved specialist college for a specified time period.

63B Application of items 14227, 14230, 14233, 14236, 14239 and 14242

Items 14227, 14230, 14233, 14236, 14239 and 14242 apply to a service in relation to a patient only if:

(a) the patient has:

(i) chronic spasticity of cerebral origin; or

(ii) chronic spasticity caused by multiple sclerosis, spinal cord injury or spinal cord disease; and

(b) oral antispastic agents have failed or have caused the patient to experience unacceptable side effects; and

(c) an authority has been given by Medicare Australia to provide the service to the patient.

64 Meaning of approved site in items 15338 and 37220

For items 15338 and 37220, approved site, in relation to radiation oncology, means a site at which radiation oncology may be performed lawfully under the law of the State or Territory in which the site is located.

64A Injection of infliximab

(1) Item 14245 applies only to a service provided by a medical practitioner who is registered by the Medicare Australia CEO to participate in the arrangements made, under paragraph 100 (1) (b) of the National Health Act 1953, for the purpose of providing an adequate pharmaceutical service for persons requiring treatment with infliximab.

(2) Item 14245 is applicable once only on the same day.

64B Meaning of expressions used in rule 64C and item 16400

In rule 64C and item 16400:

midwife means a person:

(a) who is registered, and holds a current practising certificate issued by a State or Territory regulatory authority, as a midwife; and

(b) who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

nurse means a person:

(a) who is registered, and holds a current practising certificate issued by a State or Territory regulatory authority, as a registered nurse or enrolled nurse; and

(b) who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

practice location has the same meaning as in paragraph 83 (4) (d).

regional, rural or remote area has the same meaning as in paragraph 83 (4) (d).

registered Aboriginal Health Worker means a person:

(a) who is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal Health Worker; and

(b) who is employed by, or whose services are otherwise retained by, a medical practitioner, a practice operated by a medical practitioner or a health service in relation to which the Minister has made a direction under subsection 19 (2) of the Act.

64C Application of item 16400

(1) Item 16400 applies to an antenatal service provided to a patient by a midwife, nurse or registered Aboriginal Health Worker only if:

(a) the nurse or registered Aboriginal Health Worker has the appropriate training and skills to perform an antenatal service; and

(b) the medical practitioner under whose supervision the antenatal service is provided retains responsibility for clinical outcomes and for the health and safety of the patient; and

(c) the midwife, nurse or registered Aboriginal Health Worker complies with relevant legislative or regulatory requirements regarding the provision of the antenatal service in the State or Territory where the service is provided.

(2) Item 16400 is not applicable in conjunction with another antenatal attendance item for the same patient, on the same day by the same practitioner.

(3) Item 16400 is not applicable in conjunction with items 10990, 10991 or 10992.

(4) For any particular patient, item 16400 is applicable not more than 10 times in a 9 month period.

65 Group T10 applies only in connection with certain services

(1) Each of items 20100 to 21990 (other than item 21965), 22060, 23010 to 24136, 25200 and 25205 applies to a service only if the service is provided in connection with a service that:

(a) is a professional service within the meaning of subsection 3 (1) of the Act; and

(b) is specified in an item that includes, in its description, ‘(Anaes.)’.

(2) Each of items 22900 and 22905 applies to a service only if the service is provided in connection with a dental service (other than a dental service that is a prescribed medical service under paragraph (b) of the definition of professional service in subsection 3 (1) of the Act).

66 Services specified in Subgroups 21 to 25 of Group T10

In Subgroups 21 to 25 of Group T10:

(a) a reference to anaesthesia is a reference to administration of anaesthesia performed in association with a service to which any of items 20100 to 21997, 22900 and 22905 applies; and

(b) a reference to perfusion is a reference to perfusion to which item 22060 applies; and

(c) a reference to assistance is a reference to assistance:

(i) in the administration of anaesthesia; and

(ii) to which item 25200 or 25205 applies.

67 Meaning of service time in Subgroups 21, 24, 25 and 26 of Group T10

In Subgroups 21, 24, 25 and 26 of Group T10:

service time means:

(a) in relation to administration of anaesthesia on a patient by an anaesthetist — the period that:

(i) begins when the anaesthetist commences exclusive and continuous care of the patient for anaesthesia; and

(ii) ends when the anaesthetist places the patient safely under the supervision of other personnel; and

(b) in relation to perfusion performed on a patient under anaesthesia — the period that:

(i) begins when the anaesthetic commences; and

(ii) ends with the closure of the chest of the patient; and

(c) in relation to assistance given by an assistant anaesthetist in the administration of anaesthesia performed on a patient — the period when the assistant anaesthetist is actively attending on the patient.

68 Application of Subgroup 21 of Group T10

(1) An item in the range 23010 to 24136 applies to perfusion in addition to any other item that applies to the perfusion.

(2) An item in the range 23010 to 24136 applies to assistance only as a component of item 25200 or 25205 and for the purpose of calculating the amount of fee for that item.

69 Application of Subgroups 22 and 23 of Group T10

(1) An item in the range 25000 to 25020 applies to anaesthesia in addition to any other item that applies to the anaesthesia.

(2) An item in the range 25000 to 25020 applies to perfusion in addition to any other item that applies to the perfusion.

(3) An item in the range 25000 to 25020 applies to assistance only as a component of item 25200 or 25205 and for the purpose of calculating the amount of fee for that item.

70 Meaning of amount under rule 70 in items 25025, 25030 and 25050

(1) For item 25025, amount under rule 70 means the amount that is equal to 50% of the sum of:

(a) the fee specified in any of items 20100 to 21997 and 22900 for the initiation of management of anaesthesia in association with which the anaesthesia is performed; and

(b) the fee specified in the item in the range 23010 to 24136 that applies to the anaesthesia; and

(c) if any of items 25000 to 25015 applies to the anaesthesia — the fee specified in that item; and

(d) if a service specified in an item in the range 22001 to 22050 is performed in association with the anaesthesia — the fee specified in that item.

(2) For item 25030, amount under rule 70 means the amount that is equal to 50% of the sum of:

(a) the fee specified in the item in the range 23010 to 24136 that applies to the assistance; and

(b) if any of items 25000 to 25015 applies to the assistance — the fee specified in that item; and

(c) if any of items 25200 to 25205 applies to the assistance — the fee specified in that item; and

(d) if a service specified in an item in the range 22001 to 22050 is performed in association with the assistance — the fee specified in that item.

(3) For item 25050, amount under rule 70 means the amount that is equal to 50% of the sum of:

(a) the fee specified in item 22060; and

(b) the fee specified in the item in the range 23010 to 24136 that applies to the perfusion; and

(c) if any of items 25000 to 25015 applies to the perfusion — the fee specified in that item; and

(d) if a service specified in an item in the range 22001 to 22050 or 22065 to 22075 is performed in association with the perfusion — the fee specified in that item.

71 Application of Subgroups 24 and 25 of Group T10

An item in the range 25025 to 25050 applies to the anaesthesia, assistance or perfusion in addition to any other item that applies to the service.

72 Meaning of complex paediatric case in item 25205

For item 25205, a complex paediatric case involves 1 or more of the following services:

(a) invasive monitoring, either intravascular or transoesophageal;

(b) organ transplantation;

(c) craniofacial surgery;

(d) major tumour resection;

(e) separation of conjoint twins.

73 Meaning of amount under rule 73 in items 25200 and 25205

For each of items 25200 and 25205, amount under rule 73, means the sum of:

(a) $87.55; and

(b) the fee specified in the item in the range 23010 to 24136 that applies to the assistance; and

(c) if any of items 25000 to 25020 applies to the assistance — the fee specified in that item.

74 Restriction of telepsychiatry consultations to rural and remote areas

Each of items 353 to 358 applies only to a consultation that is provided to a patient located in an R1, R2, R3, Rem1 or Rem2 area within the meaning of the Rural, Remote and Metropolitan Areas Classification.

75 Meaning of recognised emergency department and problem focussed history in Group A21

(1) In Group A21, recognised emergency department, of a private hospital, means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.

(2) In items 501, 503 and 507, problem focussed history means a history focussing on the medical condition of the patient that necessitates the patient presenting for emergency attention.

76 Prolonged attendances by emergency physicians

In items 519 to 536, an attendance for emergency evaluation of a critically ill patient with an immediately life threatening problem means an attendance that requires:

(a) immediate and rapid assessment; and

(b) initiation of resuscitation and electronic monitoring of vital signs; and

(c) taking a comprehensive history and evaluation while undertaking resuscitative measures; and

(d) ordering and evaluation of appropriate investigations; and

(e) transitional evaluation and monitoring; and

(f) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and

(g) initiation of appropriate treatment interventions; and

(h) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent.

76A Meaning of expressions used in rules 77A to 78 and Group A20

(1) The following expressions, when used in rules 77A to 77B or an item of Group A20, have the following meanings:

3 Step Mental Health Process means a service provided to a patient under item 2574, 2575, 2577, 2578, 2704, 2705, 2707 or 2708 of the Health Insurance (General Medical Services Table) Regulations 2006 as in force on 30 April 2007.

mental disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:

(a) may require medical intervention; and

(b) may be a recognised, medically diagnosable illness or disorder; and

(c) is not dementia, delirium, tobacco use disorder or mental retardation.

Note In relation to this definition, attention is drawn to the Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD‑10, Chapter 5, Primary Care Version), developed by the World Health Organisation and published in 1996.

outcome measurement tool means a tool used to monitor changes in a patient’s health that occur in response to treatment received by the patient.

(2) For rules 77B and 78, exceptional circumstances exist in relation to a service mentioned in an item for a patient if performance of the service for the patient is necessitated by:

(a) a significant change in the patient’s clinical condition; or

(b) a significant change in the patient’s care circumstances.

77A GP Mental Health Care Plans (Subgroup 1 of Group A20)

(1) For item 2710, preparation of a GP mental health care plan means the preparation of a comprehensive written plan, in consultation with a patient (and, if subrule (6) applies, the patient’s carer), that includes:

(a) assessment of the patient’s mental disorder, including administration of an outcome measurement tool (except if considered clinically inappropriate); and

(b) formulation or diagnosis or both formulation and diagnosis of the mental disorder; and

(c) treatment goals with which the patient agrees; and

(d) any actions to be taken by the patient; and

(e) a plan for crisis intervention and/or for relapse prevention, if appropriate; and

(f) referral and treatment options for the patient; and

(g) arrangements for providing the treatment and services referred to in paragraph (f); and

(h) arrangements to review the plan.

(2) For paragraph (1) (f), the referral and treatment options for a patient include:

(a) support services; and

(b) psychiatric services; and

(c) subject to the applicable limitations:

(i) psychological therapies provided by a clinical psychologist (items 80000* to 80020*); and

(ii) focussed psychological strategy services provided by a medical practitioner who is qualified in the way mentioned in paragraph 78 (1) (b) to provide those services (items 2721 to 2727); and

(iii) focussed psychological strategy services provided by an allied mental health professional (items 80100* to 80170*).

Note Asteriked items relate to a health service specified in the Health Insurance (Allied Health and Dental Services) Determination 2006.

(3) Preparation of the plan also includes:

(a) explaining to the patient (and, if subrule (6) applies, the patient’s carer) the steps involved in preparing the plan; and

(b) recording the plan; and

(c) recording the patient’s agreement to the preparation of the plan; and

(d) offering the patient (and, if subrule (6) applies, the patient’s carer):

(i) a copy of the plan; and

(ii) suitable education about the mental disorder; and

(e) adding a copy of the plan to the patient’s medical records.

(4) For item 2712, review of a GP mental health care plan means a process by which the medical practitioner:

(a) reviews the matters mentioned in subrule (1) as applicable; and

(b) checks, reinforces and expands any education given under the plan; and

(c) prepares a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and

(d) re‑administers the outcome measurement tool used in the assessment mentioned in paragraph (1) (a) (except if considered clinically inappropriate); and

(e) if different arrangements need to be made, makes amendments to the plan that state those new arrangements.

(5) Review of the plan also includes:

(a) explaining to the patient (and, if subrule (6) applies, the patient’s carer) the steps involved in the review; and

(b) recording the patient’s agreement to the review of the plan; and

(c) if amendments are made to the plan:

(i) offering a copy of the amended plan to the patient (and, if subrule (6) applies, the patient’s carer); and

(ii) adding a copy of the amended plan to the patient’s medical records.

(6) This subrule applies if:

(a) a patient has a carer; and

(b) the practitioner who is preparing or reviewing a GP mental health care plan considers it appropriate to involve the carer; and

(c) the patient agrees to the carer being involved.

77B Application of items in Subgroup 1 of Group A20

(1) Items 2710, 2712, 2713 apply only in relation to a patient with a mental disorder.

(2) Items 2710 and 2712 apply to:

(a) a patient in the community; and

(b) a private in‑patient (including a private in‑patient who is a resident of an aged care facility) being discharged from hospital.

(3) Item 2713 applies only as a surgery consultation.

(4) Unless exceptional circumstances exist, item 2710 is not applicable:

(a) in association with a service to which any of items 2713 or 734 to 779 apply; or

(b) more than once in a 12 month period for a particular patient; or

(c) within 12 months of the provision of a service in a 3 Step Mental Health Process (items 2574, 2575, 2577, 2578, 2704, 2705, 2707 and 2708); or

(d) within 3 months following the provision of a service to which item 2712 applies.

(5) Item 2712 applies only if 1 of the following services has been provided to the patient in the previous 12 months:

(a) a GP Mental Health Care Plan (item 2710);

(b) a Review of a GP Mental Health Care Plan (item 2712);

(c) a psychiatrist assessment and management plan (item 291).

(6) Item 2712 is not applicable in association with a service to which any of items 2713 or 734 to 779 apply.

(7) Unless exceptional circumstances exist, item 2712 is not applicable:

(a) more than once in a 3 month period; or

(b) within 4 weeks following provision of a GP Mental Health Care Plan item (item 2710).

(8) Item 2713:

(a) applies only to an attendance of at least 20 minutes duration; and

(b) does not apply in association with a service to which item 2710 or 2712 applies.

78 Focussed psychological strategies

(1) An item in Subgroup 2 of Group A20 applies only to a service that:

(a) is clinically indicated under a 3 Step Mental Health Process, GP Mental Health Care Plan or a Psychiatrist Assessment and Management Plan; and

(b) is provided by a medical practitioner:

(i) whose name is entered in the register maintained by the Medicare Australia CEO under section 28 of the Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

(ii) who is identified in the register as a practitioner who can provide services to which Subgroup 2 of Group A20 applies; and

(iii) who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration, for providing services to which Subgroup 2 of Group A20 applies; and

(c) is provided in a general practice that participates in the Practice Incentives Program or is an accredited general practice that is not participating in the Program.

(2) An item in Subgroup 2 of Group A20 does not apply to:

(a) a service that:

(i) is provided to a patient who has already been provided, in the calender year, with a group of 6 other services to which any of the items in that Subgroup applies; and

(ii) is provided before the medical practitioner managing the 3 Step Mental Health Process, GP Mental Health Care Plan or Psychiatrist Assessment and Management Plan has conducted a review and has noted in the patient’s records a recommendation that the patient have additional sessions of psychological strategies in the calender year; or

(b) a service that is provided to a patient who has already been provided, in the calender year, with 12 (or, if exceptional circumstances exist, 18) other services to which any of items in that Subgroup applies.

(3) In Group A20, a reference to focussed psychological strategies is a reference to any of the following mental health care management strategies, being a strategy that 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.

(4) In this rule:

general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.

78A Item 4001

(1) A service to which item 4001 applies must not be provided by a medical practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

(2) Item 4001 does not apply if a patient has already been provided, for the same pregnancy, with 3 services to which that item or item 81000*, 81005* or 81010* applies.

Note Asterisked items relate to a health service specified in the Health Insurance (Allied Health and Dental Services) Determination 2006.

(3) A reference in item 4001 to non‑directive pregnancy support counselling is a reference to counselling provided by a medical practitioner to a woman in which:

(a) information and issues relating to pregnancy are discussed; but

(b) the medical practitioner does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.

(4) A service to which item 4001 applies may be used to address any pregnancy‑related issue.

79 Meaning of qualified surgeon in items 31539 and 31545

For items 31539 and 31545, a medical practitioner is a qualified surgeon if:

(a) he or she is a specialist in the practice of his or her specialty of surgery; and

(b) the Medicare Australia CEO has received a written notice from the Royal Australasian College of Surgeons stating that the person meets the skills requirements for providing services to which the items apply.

80 Meaning of qualified radiologist in item 31542

For item 31542, a medical practitioner is a qualified radiologist if:

(a) he or she is a specialist in the practice of his or her specialty of radiology; and

(b) the Medicare Australia CEO has received a written notice from the Royal Australian and New Zealand College of Radiologists stating that the person meets the skills requirements for providing services to which the item applies.

81 Injection of botulinum toxin

(1) Each of items 18350 to 18373 applies only to a service provided by a medical practitioner who is registered by the Medicare Australia CEO to participate in the arrangements made, under paragraph 100 (1) (b) of the National Health Act 1953, for the purpose of providing an adequate pharmaceutical service for persons requiring treatment with botulinum toxin.

(2) If the cost of the botulinum toxin injection supplied in connection with a service described in each of items 18350 to 18373 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that toxin.

82 Meaning of qualified medical acupuncturist in items 193, 195, 197 and 199

For items 193, 195, 197 and 199, a person is a qualified medical acupuncturist if:

(a) the person is a general practitioner; and

(b) the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners stating that the person meets the skills requirements for providing services to which the items apply.

82A Application of item 10988

(1) In this rule and item 10988:

immunisation has the meaning given by subrule 84 (1).

registered Aboriginal health worker means a person registered as an Aboriginal health worker under the Health Practitioners Act (NT) who is employed by, or whose services are otherwise retained by, a general practice or health service in the Northern Territory in relation to which the Minister has made a direction under subsection 19 (2) of the Act.

(2) Item 10988 applies to an immunisation provided to a person by a registered Aboriginal health worker only if:

(a) the registered Aboriginal health worker is appropriately qualified and trained to provide immunisations to persons; and

(b) the medical practitioner under whose supervision the immunisation is provided retains responsibility for the health, safety and clinical outcomes of the person.

(3) If the cost of the vaccine supplied in connection with a service described in item 10988 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that vaccine.

82B Application of item 10989

(1) In this rule and item 10989:

registered Aboriginal health worker has the meaning given by subrule 82A (1).

(2) Item 10989 applies to the treatment of a person’s wound (other than normal aftercare) provided by a registered Aboriginal health worker only if:

(a) the registered Aboriginal health worker is appropriately qualified and trained to treat wounds; and

(b) the medical practitioner under whose supervision the treatment is provided has conducted an initial assessment of the person; and

(c) the registered Aboriginal health worker has been instructed by the medical practitioner in relation to the treatment of the wound; and

(d) the medical practitioner retains responsibility for the health, safety and clinical outcomes of the person.

83 Application of items 10990, 10991 and 10992

(1) If the medical service described in item 10991 is provided to a person, either that item or 10990, but not both those items, applies to the service.

(1A) If the medical service described in item 10992 is provided to a person, either that item or 10990, but not both those items, applies to the service.

(2) If item 10990, 10991 or 10992 applies to a medical service, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.

(3) For items 10990, 10991 and 10992:

bulk‑billed, in relation to a medical service, means:

(a) a medicare benefit is payable to a person in respect of the service; and

(b) under an agreement entered into under section 20A of the Act:

(i) the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

(ii) the medical practitioner accepts the assignment in full payment of his or her fee for the service provided.

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.

unreferred service means a medical service provided to a person by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.

(4) For items 10991 and 10992:

ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.

eligible area means:

(a) a regional, rural or remote area; or

(b) Tasmania; or

(c) a geographical area included in any of the following SSD spatial units:

(i) Beaudesert Shire Part A;

(ii) Belconnen;

(iii) Darwin City;

(iv) Eastern Outer Melbourne;

(v) East Metropolitan;

(vi) Frankston City;

(vii) Gosford‑Wyong;

(viii) Greater Geelong City Part A;

(ix) Gungahlin‑Hall;

(x) Ipswich City (Part in BSD);

(xi) Litchfield Shire;

(xii) Melton‑Wyndham;

(xiii) Mornington Peninsula Shire;

(xiv) Newcastle;

(xv) North Canberra;

(xvi) Palmerston‑East Arm;

(xvii) Pine Rivers Shire;

(xviii) Queanbeyan;

(xix) South Canberra;

(xx) South Eastern Outer Melbourne;

(xxi) Southern Adelaide;

(xxii) South West Metropolitan;

(xxiii) Thuringowa City Part A;

(xxiv) Townsville City Part A;

(xxv) Tuggeranong;

(xxvi) Weston Creek‑Stromlo;

(xxvii) Woden Valley;

(xxviii) Yarra Ranges Shire Part A; or

(d) the geographical area included in the SLA spatial unit of Palm Island (AC).

practice location, in relation to the provision of a medical service, means the place of practice in respect of which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Medicare Australia CEO.

regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

84 Application of item 10993

(1) For item 10993:

enrolled nurse means a person who:

(a) holds a current practising certificate as a nurse issued by a State or Territory regulatory authority; and

(b) is licensed to provide nursing care under the supervision of a registered nurse.

general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.

immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.

practice nurse means a registered nurse or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice.

registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989.

(2) Item 10993 applies to an immunisation provided to a person by a practice nurse only if:

(a) the practice nurse is appropriately qualified and trained to provide immunisations to persons; and

(b) the medical practitioner under whose supervision the immunisation is provided retains responsibility for the health, safety and clinical outcomes of the person.

(3) If the cost of the vaccine supplied in connection with a service described in item 10993 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that vaccine.

84A Application of items 10994 and 10995

(1) For items 10994 and 10995:

enrolled nurse has the meaning given by subrule 84 (1).

preventive check:

(a) includes at least 1 of the following:

(i) a check for sexually transmitted infections (including chlamydia),

(ii) taking of a sexual and reproductive history;

(ii) advice on contraception;

(iii) breast awareness education;

(iv) advice on post natal issues;

(v) continence advice and education; and

(b) may also include a smoking, nutrition, alcohol and physical activity (SNAP) behavioural risk factor assessment, and blood pressure measurement.

(2) Items 10994 and 10995 apply only if:

(a) the practice nurse is appropriately qualified and trained to perform the services provided; and

(b) the medical practitioner under whose supervision the treatment is provided retains responsibility for clinical outcomes and for the health and safety of the person.

(3) Items 10994 and 10995 do not apply to a service that is provided to a person in conjunction with a service to which any of items 10998, 10999, 2497 to 2509 and 2598 to 2616 apply.

(4) Items 10994 is not applicable in conjunction with a service to which item 10995 applies.

85 Application of item 10996

(1) For item 10996:

enrolled nurse has the meaning given by subrule 84 (1).

(2) Item 10996 applies to the treatment of a person’s wound (other than normal aftercare) provided by a practice nurse only if:

(a) the practice nurse is appropriately qualified and trained to treat wounds; and

(b) the medical practitioner under whose supervision the treatment is provided has conducted an initial assessment of the person; and

(c) the practice nurse has been instructed by the medical practitioner in relation to the treatment of the wound; and

(d) the medical practitioner retains responsibility for the health, safety and clinical outcomes of the person.

85A Meaning of expressions used in item 10997

85A Meaning of expressions used in item 10997

In item 10997:

GP management plan means a plan under item 721 or 725.

multidisciplinary care plan means a plan under items 729 or 731.

person with a chronic disease means a person who has a care plan under items 721, 723, 725, 725, 729 or 731.

registered Aboriginal health worker has the meaning given by subrule 82A (1).

team care arrangements means a plan under item 723 or 727.

86 Application of items 10998 and 10999

(1) For this rule and items 10998 and 10999:

(2) Items 10998 and 10999 apply to the taking of a cervical smear from a person by a practice nurse only if:

(a) the practice nurse is appropriately qualified and trained to take a cervical smear; and

(b) the medical practitioner under whose supervision the smear is taken retains responsibility for the health, safety and clinical outcomes of the person.

86A Application of items 30688, 30690, 30692 and 30694

86A Application of items 30688, 30690, 30692 and 30694

Item 30688, 30690, 30692 or 30694 applies to a service only if the provider makes a record of the findings of the ultrasound imaging in the patient’s notes.

87 Meaning of foreign body in items 35360 to 35363

For items 35360, 35361, 35362 and 35363, foreign body does not include an instrument inserted for the purpose of a service being rendered.

87A Application of items 35404, 35406 and 35408

(1) Items 35404, 35406 and 35408 do not apply to selective internal radiation therapy provided in combination with systemic chemotherapy using any drugs other than 5 fluorouracil (5FU) and leucovorin.

(2) Item 35404 applies only to a service provided by a medical practitioner recognised as a specialist, or consultant physician, in the specialty of nuclear medicine or radiation oncology for the purposes of the Act.

88 Limitation on certain items

(1) For any particular patient, each of items 291, 293, 10943 and 45019 is applicable not more than once in a 12 month period.

(2) For any particular patient, item 10942 is applicable not more than twice in a 12 month period.

(2A) For any particular patient, each of items 2946 to 3000 and 3032 to 3093 is applicable not more than 5 times in a 12 month period.

(3) For any particular patient, each of items 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928 and 10929 is applicable not more than once in a 36 month period.

(4) For any particular patient, item 13104 is applicable not more than 12 times in a 12 month period.

89 Application of items 30440, 30451, 30492 and 30495

A service described in item 30440, 30451, 30492 or 30495 does not include imaging.

Note The imaging services associated with these services are described in the diagnostic imaging services table.

90 Application of items 10900, 10940 and 10941

(1) A service described in item 10900 applies to any particular patient only if that patient has not received a service described in item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 in the previous 24 months.

(2) A service described in item 10940 applies to any particular patient not more than twice in any 12 month period and includes a service described in item 10941.

(3) A service described in item 10941 applies to any particular patient not more than twice in any 12 month period and includes a service described in item 10940.

91 Application of items 10931, 10932 and 10933

(1) If item 10931, 10932 or 10933 applies, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.

(2) The fee charged for the following must not exceed $125.50:

(a) the fee specified in item 10931, 10932 or 10933 is not bulk‑billed;

(b) the fee specified in any other item in this table that applies to the service is not bulk‑billed;

(c) the fee charged by an optometrist for the service.

(3) For items 10931, 10932 and 10933:

bulk‑billed, in relation to a medical service, means:

(a) a medicare benefit is payable to a person in respect of the service; and

(b) under an agreement entered into under section 20A of the Act:

(i) the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

(ii) the medical practitioner accepts the assignment in full payment of his or her fee for the service provided.

92 Limitation of items 10943, 16590, 18360, 18364 and 50303

(1) A service described in item 10943 does not apply to a service used to assess learning difficulties or learning disabilities.

(2) A service described in item 16590 is applicable not more than once in a pregnancy that has progressed beyond 20 weeks.

(3) A service described in items 18360 and 18364 is applicable to the first 4 treatments, not exceeding 2 for each limb, on any day.

(4) A service described in item 50303 is applicable once in any 12 month period for each limb.

93 Application of items 30299 and 30300

A service described in items 30299 and 30300 is applicable if only pre‑operative lymphoscinitigraphy is used because the patient is allergic to lymphotrophic dye.

94 Application of items 15556, 15559 and 15562

A service described in item 15556, 15559 or 15562 applies only if:

(a) each gross tumour target, clinical target, planning target and organ at risk specified in the prescription is rendered as a volume; and

(b) each organ at risk is nominated as a planning dose goal or constraint; and

(c) each organ at risk is specified in the prescription as a dose goal or constraint; and

(d) dose volume histograms are generated, approved and recorded with the plan; and

(e) a CT image volume dataset is required for the relevant region to be planned and treated; and

(f) the CT image is required to be suitable for the generation of quality digitally reconstructed radiographic images.

95 Application of items 38365, 38368 and 38654

A service described in item 38365, 38368 or 38654 applies to any particular patient only if:

(a) the patient:

(i) has moderate to severe chronic heart failure (New York Heart Association (NYHA) class III or IV) despite optimised medical therapy; and

(ii) has sinus rhythm; and

(iii) has a left vernicular ejection fraction of 35% or less; and

(iv) has a QRS duration of 120 milliseconds or more; or

(b) the patient satisfied the requirements mentioned in paragraph (a) immediately before the insertion of a cardiac resynchronisation therapy device and transvenous left ventricular electrode.

96 Application of items 38470 to 38766

An item in the range 38470 to 38766 must be performed using open exposure or minimally invasive surgery unless otherwise stated in the item.

97 Application of items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613, 2616

Items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613, 2616 do not apply in conjunction with any of items 10994, 10995, 10998 and 10999.

98 Application of item 35412

(1) Intra‑operative imaging is taken to be part of the service associated with the coiling of an aneurysm and cannot be charged in addition to item 35412.

(2) Pre‑operative diagnostic imaging, including aftercare, under item 60009, 60072, 60075 or 60078 of the diagnostic imaging services table may be separately claimed.