1
Name
1 Name
This instrument is the Health Insurance (General Medical Services Table) Regulations 2021.
//
© 2026 Zoe. All rights reserved.
Zoe is a legal information platform. Always consult the Federal Register of Legislation for authoritative text.
Commonwealth legislation
This law sets out the Medicare Benefits Schedule for general medical services: which doctor consultations and treatments attract a Medicare rebate, who may provide them, and how much Medicare pays. It determines eligibility, timing and conditions for claiming.
It directly affects patients (what’s rebated), doctors (what and how they may bill) and Medicare (the rules for processing claims), making routine, chronic and urgent care financially and administratively consistent.
Want the full deep dive?
Zoe can write the in-depth analysis on top of the summary above: how it works, who it affects and what each part actually does.
Direct links to the current provisions in Health Insurance (General Medical Services Table) Regulations 2021.
This instrument is the Health Insurance (General Medical Services Table) Regulations 2021.
This instrument is made under the Health Insurance Act 1973.
For the purposes of subsection 4(1) of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of medical services.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
This instrument is the Health Insurance (General Medical Services Table) Regulations 2021.
This instrument is made under the Health Insurance Act 1973.
For the purposes of subsection 4(1) of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of medical services.
Schedule 1—General medical services table
Note: See section 4.
The Dictionary in Part 7 defines certain words and expressions that are used in this Schedule, and includes references to certain words and expressions that are defined elsewhere in this Schedule.
(1) In this Schedule:
eligible non‑vocationally recognised medical practitioner means:
(a) a medical practitioner:
(i) who is registered under the MedicarePlus for Other Medical Practitioners Program; and
(ii) who successfully completed the requirements of that Program, as evidenced by written advice from the Chief Executive Medicare; or
Note: The MedicarePlus for Other Medical Practitioners Program will cease on 31 December 2023.
(b) a medical practitioner who:
(i) as at 30 June 2023, was registered under:
(A) the After Hours Other Medical Practitioners Program; or
(B) the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; or
(C) the Rural Other Medical Practitioners’ Program; and
(ii) is registered under, and providing general medical services in accordance with, the Other Medical Practitioners Extension Program; or
(c) a medical practitioner:
(i) who is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and
(ii) providing general medical services in accordance with that Program.
Note: The MedicarePlus for Other Medical Practitioners Program will cease on 31 December 2023.
(2) In subclause (1):
After Hours Other Medical Practitioners Program means the program by that name that, before 1 July 2023, was administered by the Chief Executive Medicare.
MedicarePlus for Other Medical Practitioners Program means the program by that name administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
Other Medical Practitioners Extension Program means the program by that name administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program means the program by that name that, before 1 July 2023, was administered by the Chief Executive Medicare.
Rural Other Medical Practitioners’ Program means the program by that name that, before 1 July 2023, was administered by the Chief Executive Medicare.
Note 1: The After Hours Other Medical Practitioners Program, the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program and the Rural Other Medical Practitioners’ Program ceased on 30 June 2023.
Note 2: The MedicarePlus for Other Medical Practitioners Program will cease on 31 December 2023.
For the purposes of paragraph (b) of the definition of general practitioner in subsection 3(1) of the Act, the following medical practitioners are specified: (a) a medical practitioner who is undertaking a placement in general practice that is approved by the Royal Australian College of General Practitioners (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; (b) an eligible non‑vocationally recognised medical practitioner; (c) a medical practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited; (d) a medical practitioner who is undertaking a placement in general practice that is approved by the Australian College of Rural and Remote Medicine (the ACRRM): (i) as part of a training program for general practice leading to the award of Fellowship of the ACRRM; or (ii) as part of another training program recognised by the ACRRM as being of an equivalent standard.
Note: For other medical practitioners who are general practitioners, see the definition of general practitioner in subsection 3(1) of the Act and section 16 of the Health Insurance Regulations 2018.
In this Schedule:
multidisciplinary case conference means a process by which a multidisciplinary case conference team 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 multidisciplinary 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 multidisciplinary case conference team;
(e) assessing whether previously identified outcomes (if any) have been achieved.
(1) In this Schedule, a multidisciplinary case conference team for a patient: (a) includes a medical practitioner; and (b) either: (i) for items 235, 236, 237, 238, 239, 240, 735, 739, 743, 747, 750, 758, 825 to 828, 930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 6029 to 6042 and 6064 to 6075—includes at least 2 other members; or (ii) for an item mentioned in subclause (3)—includes at least 3 other members; and (c) may also include a family member of the patient. (2) For the members mentioned in paragraph (1)(b): (a) each member must provide a different kind of care or service to the patient; and (b) each member must not be an unpaid carer of the patient; and (c) one member may be another medical practitioner.
Note: Example: Other members may be allied health and other primary health care professionals, home and community service providers and care organisers, including the following:
(a) Aboriginal and Torres Strait Islander health practitioners;
(b) asthma educators;
(c) audiologists;
(d) dental therapists;
(e) dentists;
(f) diabetes educators;
(g) dietitians;
(h) mental health workers;
(i) occupational therapists;
(j) optometrists;
(k) orthoptists;
(l) orthotists or prosthetists;
(m) pharmacists;
(n) physiotherapists;
(o) podiatrists;
(p) psychologists;
(q) registered nurses;
(r) social workers;
(s) speech pathologists;
(t) education providers;
(u) “meals on wheels” providers;
(v) personal care workers;
(w) probation officers.
(3) For the purposes of subparagraph (1)(b)(ii), the items are items 820, 822, 823, 830, 832, 834, 2946, 2949, 2954, 2978, 2984, 2988, 3032, 3040, 3044, 3069 and 3074.
(1) Use this clause for items 104 to 133, 385 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 6018, 6019, 6024, 6051, 6052, 6058, 6062, 6063, 16401, 16404, 16406, 51700, 51703, 91825, 92422, 92423, 92440 and 92443. (2) A single course of treatment for a patient: (a) includes: (i) the initial attendance on the patient by a specialist or consultant physician; and (ii) 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 (iii) 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; but (b) does not include: (i) referral of the patient to the specialist or consultant physician; or (ii) 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 section 102 of the Health Insurance Regulations 2018 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.
Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.
An item in this Schedule including the symbol (H) applies only to a service performed or provided in a hospital.
A reference in this Schedule to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service.
An item in this Schedule does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.
(1) Use this clause for items 104 to 111, 115 to 137, 141 to 147, 289 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 6018 to 6028, 6051 to 6063, 16401, 16404, 16407, 16408, 16508, 16509, 16533, 16534, 17640 to 17655, 90260, 90261, 90266, 90267, 91825, 92172, 92173, 92423, 92436, 92440, 92441, 92442, 92443, 92444, 92445, 92446, 92447, 92448, 92612, 92613, 92614 and 92624. (2) The item does not apply to an attendance on a patient by a specialist or consultant physician if: (a) the attendance forms part of a single course of treatment for the patient; and (b) the attendance is after the end of the period of validity (under section 102 of the Health Insurance Regulations 2018) of the referral that was valid for the initial attendance on the patient by the specialist or consultant physician in the single course of treatment; and (c) the attendance is not within the period of validity (under section 102 of the Health Insurance Regulations 2018) of a later referral.
Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.
(1) Use this clause for items 52, 53, 54, 57, 104, 105 and 151. (2) The item does not apply to an attendance on a patient by a specialist in the specialty of diagnostic radiology if the attendance is in association with a service to which any of the following items of the diagnostic imaging services table applies: (a) an item in Subgroup 6 of Group I1; (b) an item in any of Subgroups 1 to 7 of Group I3; (c) items 58900 and 58903 in Subgroup 8 of Group I3; (d) item 59103 in Subgroup 9 of Group I3. (3) The item also does not apply to an attendance on a patient if the attendance is in association with a service to which an item in Group I5 of the diagnostic imaging services table applies, unless the practitioner providing the service considers the attendance is necessary for the management or treatment of the patient.
(1) Use this clause for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6009 to 6015, 6019, 6052, 16404, 91823, 91825, 91826, 91833, 91836, 92611, 92612, 92613, 92614, 92618, 92440, 92445, 92446 and 92447.
Note: Some of these items are specified in determinations made under subsection 3C(1) of the Act.
(2) The item does not apply to a service if: (a) the service is an attendance on a patient by a specialist or a consultant physician on the same day as the day on which an operation is performed on the patient by the specialist or consultant physician; and (b) the operation is a service to which an item in Group T8 applies; and (c) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $349.95 or more.
(1) Use this clause for items 3 to 338, 348 to 388, 392, 393, 410 to 417, 585 to 600, 701 to 707, 715, 733, 737, 741, 745, 761, 763, 766, 769, 772, 776, 788, 789, 792, 900, 903, 965, 967, 969, 971, 972, 973, 975, 986, 2497 to 2840, 3005 to 3028, 5000 to 5267, 6007 to 6015, 6018 to 6024, 6051 to 6063, 13899, 16401, 16404, 16406, 16407, 16508, 16509, 16533, 16534, 17610 to 17690, 90020 to 90096, 90098, 90183, 90188, 90202, 90212, 90215, 90250 to 90278, 92004 and 92011. (2) A professional attendance includes the provision, for a patient, of any of the following services: (a) evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the Act; (b) formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions; (c) giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment; (d) if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment; (e) providing appropriate preventive health care; (f) recording the clinical details of the service or services provided to the patient. (3) However, a professional attendance does not include the supply of a vaccine to a patient if: (a) the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 65, 123, 124, 151, 165, 179, 181, 185, 187, 189, 191, 203, 206, 301, 303, 5000 to 5267 and 90020 to 90098; and (b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
(1) Use this clause for items 3 to 147, 151, 165, 177, 179, 181, 185, 187, 189, 191, 193 to 338, 348 to 388, 410 to 417, 585 to 600, 733, 737, 741, 745, 761, 763, 766, 769, 772, 776, 788, 789, 792, 2497 to 2840, 3005 to 3028, 35570, 35571, 35573, 35577, 35581, 35582, 35585, 4001 to 6015, 6018 to 6024, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11705, 11724, 11731, 12000 to 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14216, 14219, 14224, 14255 to 14288, 15942, 15944, 15946, 15948, 16003 to 16512, 16515 to 51318, 90020 to 90096, 90098, 90183, 90188, 90202, 90212, 90215 and 90250 to 90278. (2) The item applies to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion. (3) A personal attendance by the medical practitioner on the patien
This is an opening excerpt, not the complete document.