Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018
Part 1Services and fees—Non‑Specialist Practitioner services
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This Determination is the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.
3. Authority
This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
4. Definitions
(1) In this Determination:
Act means the Health Insurance Act 1973.
general medical services table means the table prescribed under section 4 of the Act as in force from time to time.
general practitioner has a meaning affected by clause 1.1.3 of the general medical services table.
has effect: when this Determination refers to a provision of the general medical services table as having effect, the provision of the general medical services table has effect as a provision of this Determination.
prescribed medical practitioner means a medical practitioner who is not a general practitioner, specialist or consultant physician, and who:
(a) is registered under section 3GA of the Act, to the extent that the person is practicing during the period in respect of which, and in the location in respect of which, he or she is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or
(b) is covered by an exemption under subsection 19AB(3) of the Act; or
(c) first became a medical practitioner before 1 November 1996.
relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this Determination.
Note: The following terms are defined in subsection 3(1) of the Act:
clinically relevant service
consultant physician
item
professional service
specialist
(2) Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
5. Treatment of relevant services
For subsection 3C(1) of the Act a relevant service, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, as if:
Part Part 1 - Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 - Services and fees—Non‑Specialist Practitioner services | Zoe
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
6. Application of general provisions of the general medical services table
(1) Clause 1.2.1 of the general medical services table shall have effect as if an item in Schedule 1 of this Determination were specified in Schedule 1 of the general medical services table.
(2) Clause 1.2.5 of the general medical services table shall have effect as if:
(a) an item in Schedule 1 of this Determination were specified in subclause 1.2.5(1) of the general medical services table; and
(b) an item in Schedule 1 of this Determination were specified in subclause 1.2.5(3) of the general medical services table.
(3) Clause 1.2.7 of the general medical services table shall have effect as if an item in Schedule 1 of this Determination were also specified in subclause 1.2.7(1).
(4) Clause 1.2.8 of the general medical services table shall have effect as if an item in Schedule 1 of this Determination were also specified in clause 1.2.8.
(5) Clause 1.2.9 of the general medical services table shall have effect as if an item in Schedule 1 of this Determination were also specified in clause 1.2.9.
(6) Clause 1.2.10 of the general medical services table shall have effect as if an item in Schedule 1 of this Determination were also specified in clause 1.2.10.
7. Indexation
(1)
At the start of 1 July 2025 (the
indexation time
), each amount covered by subsection
(2) is replaced by the amount worked out using the following formula:
1.024 multiplied by the amount immediately before the indexation time
Note: The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).
(2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.
(3) To avoid doubt, a fee listed in table 1.1.1 is not indexed under subsection (1).
(4) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).
Schedule 1 – relevant services
Part 1—Services and fees—Non‑Specialist Practitioner services
Division 1.1—Services and fees—Multiple patients in a single attendance
1.1.1 Meaning of amount under table 1.1.1
(1) An amount under table 1.1.1, for an item mentioned in column 1 of table 1.1.1, means the sum of:
(a) the fee for the item mentioned in column 2 of the table; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance—the amount mentioned in column 4 for the item.
Division 1.10—Services and fees—Non‑Specialist Practitioner after‑hours attendances to which no other item applies
1.10.1 Application of items in Division 1.10
(1) Clause 2.24.1 of the general medical services table shall have effect as if:
(a) items 733, 745, 766 and 776 were also specified in subclause 2.24.1(1).
(b) all items in Division 1.10 were also specified in subclause 2.24.1(2).
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span style="font-weight:bold">Group A7 – Acupuncture and Non</span><span style="font-weight:bold">‑</span><span style="font-weight:bold">Specialist Practitioner Items</span></p></td></tr><tr><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span style="font-weight:bold">Subgroup 10 – Prescribed Medical Practitioner after‑hours attendances to which no other item applies</span></p></td><td style="width:17.28%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="font-size:10pt"><span style="font-weight:bold"></span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span style="font-weight:bold">Item</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span style="font-weight:bold">Description</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:right; font-size:10pt"><span style="font-weight:bold">Fee ($)</span></p></td></tr></thead><tbody><tr><td style="width:14.56%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>733</span></p></td><td style="width:68.16%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which another item applies) by a prescribed medical practitioner—each attendance</span></p></td><td style="width:17.28%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="text-align:right; font-size:10pt"><span>25.50</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>737</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes in duration (other than a service to which another item applies) by a prescribed medical practitioner—each attendance</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="text-align:right; font-size:10pt"><span>43.10</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>741</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes in duration (other than a service to which another item applies) by a prescribed medical practitioner—each attendance</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="text-align:right; font-size:10pt"><span>73.95</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>745</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance at consulting rooms of more than 45 minutes in duration but not more than 60 minutes (other than a service to which another item applies) by a prescribed medical practitioner—each attendance</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="text-align:right; font-size:10pt"><span>103.70</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>761</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance by a prescribed medical practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting not more than 5 minutes—an attendance on one or more patients on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>763</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance by a prescribed medical practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 5 minutes, but not more than 25 minutes—an attendance on one or more patients on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>766</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance by a prescribed medical practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 25 minutes, but not more than 45 minutes—an attendance on one or more patients on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>769</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance by a prescribed medical practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 45 minutes, but not more than 60 minutes—an attendance on one or more patients on one occasion—each patient.</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>772</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self</span><span>‑</span><span>contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self</span><span>‑</span><span>contained unit) of not more than 5 minutes in duration by a prescribed medical practitioner—an attendance on one or more patients at one residential aged care facility on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>776</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self</span><span>‑</span><span>contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self</span><span>‑</span><span>contained unit) of more than 5 minutes in duration but not more than 25 minutes in duration by a prescribed medical practitioner—an attendance on one or more patients at one residential aged care facility on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr style="height:11.6pt"><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>788</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self</span><span>‑</span><span>contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self</span><span>‑</span><span>contained unit) of more than 25 minutes in duration but not more than 45 minutes by a prescribed medical practitioner—an attendance on one or more patients at one residential aged care facility on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>789</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self</span><span>‑</span><span>contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self</span><span>‑</span><span>contained unit) of more than 45 minutes but not more than 60 minutes in duration by a prescribed medical practitioner—an attendance on one or more patients at one residential aged care facility on one occasion—each patient</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>2197</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance at consulting rooms of more than 60 minutes in duration (other than a service to which another item applies) by a prescribed medical practitioner—each attendance.</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="text-align:right; font-size:10pt"><span>176.20</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>2198</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance by a prescribed medical practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies), lasting more than 60 minutes—an attendance on one or more patients on one occasion—each patient.</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr><tr><td style="width:14.56%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; text-align:justify; font-size:10pt"><span>2200</span></p></td><td style="width:68.16%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self</span><span>‑</span><span>contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self</span><span>‑</span><span>contained unit) of more than 60 minutes in duration by a prescribed medical practitioner—an attendance on one or more patients at one residential aged care facility on one occasion—each patient.</span></p></td><td style="width:17.28%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Item" style="margin-left:0pt; font-size:10pt"><span>Amount under clause</span><span> </span><span>1.1.1</span></p></td></tr></tbody></table>