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This instrument is the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020.
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Commonwealth legislation
What this instrument does (mechanically)
Treats a list of services performed by participating midwives and participating nurse practitioners as eligible for Medicare benefits by making those services operate “as if” they were items in the general medical services table or pathology services table (see sections 8, 13 and 14). In practice that means Medicare can pay benefits for these non‑medical practitioners when they meet the instrument’s conditions.
Prescribes the precise MBS item numbers, descriptions and fees for: midwifery services (Schedule 1, Group M13), nurse practitioner clinical and procedural services (Schedule 2, Group M14), simple pathology tests performed by nurse practitioners (Schedule 2, Part 1, Group P9), and nurse practitioner assistance at operations (Schedule 2, Group M33). Fees and item rules are shown in the Schedules (see Schedules 1 and 2).
Sets rules and limits about when an item can be claimed: e.g. that the service must be a personal attendance by a single participating midwife/nurse practitioner with the patient present (general requirement — section 10 for midwives; section 16 for nurse practitioners); timing and minimum duration requirements for many items; one‑per‑pregnancy or maximum‑per‑period caps for specific items; hospital‑only items marked with the symbol (H) (section 6B and many item descriptions); and special limits (for example item 73826 is limited to 3 applications per 12 months per patient up to an aggregate cap – see section 20).
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Direct links to the current provisions in Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020.
This instrument is the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020.
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
(1) In this instrument:
Act means the Health Insurance Act 1973.
amount under clause 2.1 has the meaning given by clause 2.1 of Part 2 of Schedule 2.
amount under clause 3.1 has the meaning given by clause 3.1 of Part 3 of Schedule 2.
amount under clause 3.2 has the meaning given by clause 3.2 of Part 3 of Schedule 2.
amount under clause 3.3 has the meaning given by clause 3.3 of Part 3 of Schedule 2.
non‑medicare service means a service provided by a nurse practitioner other than a service that is generally accepted in the nursing profession as being necessary for the appropriate treatment of the patient to whom it is rendered.
relevant provisions means all provisions, relating to professional services or medical services, of:
(a) the Act and regulations made under the Act; and
(b) the National Health Act 1953 and regulations made under that Act.
Note The following terms are defined in subsection 3(1) of the Act:
Note: general medical services table
Note: participating midwife
Note: participating nurse practitioner
Note: pathology services table
(2) Unless the contrary intention appears, a reference in this instrument 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.
(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:
start formula 1.024 times the amount immediately before the indexation time end formula
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 a Schedule of this Determination, other than the fee for the following:
(a) an item in Group P9.
(3) 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).
(1) An item in this instrument including the symbol (H) applies only to a service performed or provided in a hospital.
Part 2 Midwifery services
(1) In this Part:
birth includes episiotomy and repair of tears.
(2) For this Part, a participating midwife is a member of a practice that provides a patient’s antenatal care if the midwife:
(a) participates (whether as a partner, employee or otherwise) in the provision of professional services as part of the practice; or
(b) provides relief services to the practice; or
(c) provides professional services as part of the practice as a locum.
For subsection 3C(1) of the Act, a midwifery service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Schedule 1 for the service.
(1) An item in Schedule 1 applies to a service only if:
(a) the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating midwife; and
(b) the midwife:
(i) is not employed by the proprietor of a hospital that is not a private hospital; or
(ii) both:
(A) is employed by the proprietor of a hospital that is not a private hospital; and
(B) provides the service otherwise than in the course of employment by that proprietor.
(2) Subsection (1) applies whether or not another person provides essential assistance to the participating midwife in accordance with accepted clinical practice.
(3) An item in Schedule 1 does not apply to a service provided for a patient if the patient is not in attendance.
Examples — patient not in attendance
1 Completing patient records.
2 Issuing repeat prescriptions.
3 Telephone attendances.
(4) In items 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1:
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.
(5) 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 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
(6) If a service described in item 82103 is provided on the same day as a service to which item 82100, 82102, 82105, 82110, 91211, 91212, 91218 or 91219 applies, the subsequent item will only apply if it is:
(a) not a continuation of the first attendance; and
(b) is clinically relevant and distinct from the first attendance.
(1) Items 82116, 82118, 82120, 82123, 82125 and 82127 in Part 1 of Schedule 1 apply only to a service provided by a participating midwife during a period of exclusive care of a patient in labour.
(2) Items 82116, 82118, 82120, 82123, 82125 and 82127 in Part 1 of Schedule 1 do not apply if, before labour, the patient’s care is transferred to an obstetrician or medical practitioner who provides obstetric services, for the obstetrician or practitioner to manage the labour and birth.
(3) Items 82118 and 82120 in Part 1 of Schedule 1 applies to a service provided by a participating midwife (the first midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the first midwife to another participating midwife in order to manage fatigue experienced by the first midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
(4) Items 82123 and 82125 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the second midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the second midwife to another participating midwife in order to manage fatigue experienced by the second midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
(5) Item 82127 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the third midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the third midwife to another participating midwife to manage fatigue experienced by the third midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
Part 3 Nurse practitioner services
Subject to section 14, for subsection 3C(1) of the Act, a nurse practitioner service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Schedule 2 relating to the service.
For subsection 3C(1) of the Act, a nurse practitioner service described in Part 1 of Schedule 2 provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the pathology services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Part 1 of Schedule 2 relating to the service.
Note 1 A participating nurse practitioner performing a service described in items 73828 to 73837 must be the patient’s treating practitioner in order for medicare benefit to be payable — see subsection 16A(7A) of the Act.
(1) For a patient, an item in Schedule 2 applies only if the service mentioned in that item is within the scope of practice of the participating nurse practitioner who provides the service.
(1) An item in Schedule 2, except an item in Part 1 of Schedule 2, applies to a service only if:
(a) the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating nurse practitioner; and
(b) the nurse practitioner:
(i) is not employed by the proprietor of a hospital that is not a private hospital; or
(ii) both:
(A) is employed by the proprietor of a hospital that is not a private hospital; and
(B) provides the service otherwise than in the course of employment by that proprietor.
(2) Subsection (1) applies whether or not another person provides essential assistance to the participating nurse practitioner in accordance with accepted clinical practice.
(3) An item in Schedule 2, except an item in Part 1 of Schedule 2, does not apply to a service provided for a patient if the patient is not in attendance.
Examples — patient not in attendance
1 Completing patient records.
2 Issuing repeat prescriptions.
3 Telephone attendances.
(4) In Part 2 of Schedule 2:
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.
(5) 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 Part 2 of Schedule 2; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
(6) Items 82200, 82205, 82210 and 82215 do not apply to a service described in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.
An item in Part 1 of Schedule 2 applies to a service only if the participating nurse practitioner who renders the service:
(a) is not employed by the proprietor of a hospital that is not a private hospital; or
(b) both:
(i) is employed by the proprietor of a hospital that is not a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
Section 7 of the Health Insurance (Prescribed Pathology Services) Determination 2021 shall have effect as if the services specified in items 73826 to 73837 of Schedule 2 Part 1 were also specified in that section.
Item 73826 does not apply to a service provided to a patient who has already been provided, in the last 12 months, 4 other services to which any of the following apply:
(a) item 73826;
(b) item 66551;
(c) item 73812.
(1) Item 73825 applies to a service only if:
(a) the service is rendered at, or from, a practice location in:
(i) a Modified Monash 6 area; or
(ii) a Modified Monash 7 area;
(b) the nurse practitioner providing the service:
(i) is employed by an organisation that:
(A) delivers health services; and
(B) is participating in the First Nations Molecular Point‑of‑Care (PoC) Testing Program;
(c) the service is provided in accordance with the Program referred to in subparagraph (b)(i)(B);
(d) the service is conducted by a nurse practitioner who has achieved competency as a PoC operator by the First Nations Molecular PoC Testing Program for the test(s) performed; and
(e) the PoC test(s) gives valid patient result(s).
Part 4 Transitional provisions
(1) Between 1 March 2022 and 31 August 2022, item 82115 will apply to a service provided to a patient where the participating midwife has not had at least 2 antenatal attendances with the patient in the 6 months prior to the service provided to the patient.
Schedule 1 Midwifery services and fees
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-weight:bold">Group M13 – Midwifery services</span></p></td></tr><tr><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-weight:bold">Subgroup 1 – MBS items for participating midwives</span></p></td></tr><tr><td style="width:12.9%; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Column 1</span></p><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:73.1%; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Column 2</span></p><p style="margin-top:3pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Service</span></p></td><td style="width:14%; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; text-align:right; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Column 3</span></p><p style="margin-top:3pt; margin-left:23.05pt; margin-bottom:3pt; page-break-after:avoid; line-height:10pt"><span style="font-size:10pt; font-weight:bold">Fee ($)</span></p></td></tr></thead><tbody><tr style="height:141.3pt"><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82100</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Initial antenatal professional attendance by a participating midwife, lasting at least 60 minutes, including all the following:</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>taking a detailed patient history;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>performing a comprehensive examination;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>performing a risk assessment;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>based on the risk assessment</span><span> </span><span>— arranging referral or transfer of the patient’s care to an obstetrician;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(e)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>requesting pathology and diagnostic imaging services, when necessary;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Payable only once per pregnancy</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>84.70</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82102</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Long antenatal professional attendance by a participating midwife, lasting at least 90 minutes</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>127.00</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82103</span></p></td><td style="width:73.1%; 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="tabletext0" style="margin-top:0pt; margin-bottom:4pt; line-height:12pt; background-color:#ffffff"><span style="font-size:11pt">Complex antenatal professional attendance by a participating midwife leading to a hospital admission and lasting at least 3 hours.</span></p><p class="tabletext0" style="margin-top:0pt; margin-bottom:4pt; line-height:12pt; background-color:#ffffff"><span style="font-size:11pt">A maximum of 3 services per pregnancy.</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Not being a service associated with a service to which intrapartum items 82116, 82118, 82120, 82123, 82125 or 82127 applies (H)</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>234.20</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82104</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Long postnatal professional attendance by a participating midwife, lasting at least 90 minutes, within 6 weeks after birth</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>186.75</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82105</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Short antenatal professional attendance by a participating midwife, lasting at least 10 minutes</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>33.60</span></p></td></tr><tr style="height:8.4pt"><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82110</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Routine antenatal professional attendance by a participating midwife, lasting at least 40 minutes</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>84.70</span></p></td></tr><tr style="height:393pt"><td style="width:12.9%; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><a id="CU_720357"></a><a id="_Hlk97636066"><span>82115</span></a></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment and preparation of a maternity care plan for a patient whose pregnancy has progressed beyond 28 weeks, where the participating midwife has had at least 2 antenatal attendances with the patient in the preceding 6 months, if:</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is not an admitted patient of a hospital; and</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the participating midwife undertakes a comprehensive assessment of the patient; and</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the participating midwife develops a written maternity care plan that contains:</span></p><p style="margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:25.92pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>outcomes of the assessment; and</span></p><p style="margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:22.86pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>details of agreed expectations for care during pregnancy, labour and birth; and</span></p><p style="margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:19.81pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>details of any health problems or care needs; and</span></p><p style="margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:20.42pt; text-indent:0pt; display:inline-block"></span><span>(iv)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and</span></p><p class="Item" style="margin-top:0pt; margin-left:43.4pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span style="width:23.47pt; text-indent:0pt; display:inline-block"></span><span>(v)</span><span style="width:7.1pt; text-indent:0pt; display:inline-block"> </span><span>details of any referrals or requests for pathology services or diagnostic imaging services for the patient during the pregnancy, and any additional referrals or requests that may be required for the patient; and</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the maternity care plan is explained and agreed with the patient; and</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(e)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the fee does not include any amount for the management of labour and birth;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>(Includes any antenatal attendance provided on the same occasion)</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Payable only once for any pregnancy;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>This item cannot be claimed if items</span><span> </span><span>16590 or 16591 have previously been claimed during a single pregnancy, except in exceptional circumstances</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>331.90</span></p></td></tr><tr style="height:43.85pt"><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82116</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Management of labour for up to 6 hours, not including birth, at a place other than a hospital if:</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(a) the attendance is by the participating midwife who:</span></p><p style="margin-top:3pt; margin-left:25.5pt; margin-bottom:3pt; line-height:12pt"><span>(i) provided the patient's antenatal care or</span></p><p style="margin-top:3pt; margin-left:42.5pt; margin-bottom:3pt; text-indent:-17pt; line-height:12pt"><span>(ii) is a member of a practice that has provided the patient's antenatal care; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(b) the total attendance time is documented in the patient notes;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>This item does not apply if birth is performed during the attendance;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Only claimable once per pregnancy</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>783.85</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82118</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Management of labour for up to 6 hours total attendance, </span><a id="_Hlk89444980"><span>including birth where performed or attendance and immediate post</span><span>‑</span><span>birth care at an elective caesarean section </span></a><span>if:</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(a) the patient is an admitted patient of a hospital; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(b) the attendance is by the first participating midwife who:</span></p><p style="margin-top:3pt; margin-left:39.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(i) assisted or provided the patient's antenatal care; or</span></p><p style="margin-top:3pt; margin-left:39.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(ii) is a member of a practice that has provided the patient's antenatal care; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(c) the total attendance time is documented in the patient notes.</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>(Includes all hospital attendances related to the labour by the first participating midwife)</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Only claimable once per pregnancy;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Not being a service associated with a service to which item</span><span> </span><span>82120 applies (H)</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>783.85</span></p></td></tr><tr style="height:43.85pt"><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><a id="_Hlk97636199"><span>82120</span></a></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Management of labour between 6 and 12 hours total attendance, including birth where performed, if:</span></p><p style="margin-left:51.9pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span>(a) the patient is an admitted patient of a hospital; and</span></p><p style="margin-left:51.9pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span>(b) the attendance is by the first participating midwife who:</span></p><p style="margin-top:3pt; margin-left:39.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(i) assisted or provided the patient’s antenatal care; or</span></p><p style="margin-top:3pt; margin-left:39.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(ii) is a member of a practice that provided the patient’s antenatal care; and</span></p><p style="margin-left:51.9pt; margin-bottom:3pt; text-indent:-43.4pt; line-height:12pt"><span>(c) the total attendance time is documented in the patient notes;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>(</span><a id="_Hlk89445131"><span>Includes all hospital attendances related to the labour by the first participating midwife</span></a><span>)</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Only claimable once per pregnancy;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Not being a service associated with a service to which item</span><span> </span><span>82118 applies (H)</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>1,567.70</span></p></td></tr><tr style="height:43.85pt"><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82123</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Management of labour for up to 6 hours total attendance, including birth where performed if:</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(a) the patient is an admitted patient of a hospital; and</span></p><p style="margin-top:3pt; margin-left:22.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(b) the attendance is by the second participating midwife who either:</span></p><p style="margin-top:3pt; margin-left:22.7pt; margin-bottom:3pt; line-height:12pt"><span>(i) assisted or provided the patient's antenatal care; or</span></p><p style="margin-top:3pt; margin-left:36.9pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(ii) is a member of a practice that has provided the patient's antenatal care; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(c) the total attendance time is documented in the patient notes;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>(Includes all hospital attendances related to the labour by the second participating midwife)</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Only claimable once per pregnancy;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Not being a service associated with a service to which item</span><span> </span><span>82125 applies (H)</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>783.85</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><a id="_Hlk97636361"><span>82125</span></a></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Management of labour between 6 and 12 hours total attendance, including birth where performed, if:</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(a) the patient is an admitted patient of a hospital; and</span></p><p style="margin-top:3pt; margin-left:22.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(b) the attendance is by the second participating midwife who either:</span></p><p style="margin-top:3pt; margin-left:36.9pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(i) assisted or provided the patient’s antenatal care; or</span></p><p style="margin-top:3pt; margin-left:36.9pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(ii) is a member of a practice that provided the patient’s antenatal care; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(c) the total attendance time is documented in the patient notes;</span></p><p style="margin-bottom:3pt; line-height:12pt"><span>(Includes all hospital attendances related to the labour by the second participating midwife)</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Only claimable once per pregnancy;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Not being a service associated with a service to which item</span><span> </span><span>82123 or 82127 applies (H)</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>1,567.70</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82127</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Management of labour for up to 6 hours total attendance, including birth where performed if:</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(a) the patient is an admitted patient of a hospital; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(b) the attendance is by a third participating midwife who either:</span></p><p style="margin-top:3pt; margin-left:25.5pt; margin-bottom:3pt; line-height:12pt"><span>(i) assisted or provided the patient's antenatal care; or</span></p><p style="margin-top:3pt; margin-left:39.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(ii) is a member of a practice that has provided the patient's antenatal care; and</span></p><p style="margin-top:3pt; margin-left:22.7pt; margin-bottom:3pt; text-indent:-14.2pt; line-height:12pt"><span>(c) an attendance to which item</span><span> </span><span>82123 applies has been provided by a second participating midwife who is a member of a practice that has provided the patient's antenatal care; and</span></p><p style="margin-top:3pt; margin-left:8.5pt; margin-bottom:3pt; line-height:12pt"><span>(d) the total attendance time is documented in the patient notes;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>(Includes all hospital attendances related to the labour by the third participating midwife)</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Only claimable once per pregnancy;</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Not being a service associated with a service to which item</span><span> </span><span>82125 applies (H)</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>783.85</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82130</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Short postnatal professional attendance by a participating midwife, lasting at least 20 minutes, within 6 weeks after birth</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>55.55</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><a id="CU_1223017"></a><span>82135</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Routine postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after birth</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>124.50</span></p></td></tr><tr><td style="width:12.9%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>82140</span></p></td><td style="width:73.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Postnatal professional attendance by a participating midwife on a patient, not less than 4 weeks but not more than 8 weeks after birth of a baby, lasting at least 60 minutes, including all of the following:</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>a comprehensive examination of the patient and baby to ensure normal postnatal recovery;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>a labour and birth debrief;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>a mental health assessment or where the patient declines a mental health assessment, the participating midwife records the patient’s decision in the clinical notes;</span></p><p style="margin-left:26.65pt; margin-bottom:3pt; text-indent:-26.65pt; line-height:12pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>referral of the patient to a primary carer for the ongoing care of the patient and baby or where the patient declines a referral to a primary carer, the participating midwife records the patient’s decision in the clinical notes</span></p><p style="margin-top:3pt; margin-bottom:3pt; line-height:12pt"><span>Payable only once per pregnancy</span></p></td><td style="width:14%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:12pt"><span>55.55</span></p></td></tr></tbody></table>
Schedule 2 Nurse practitioner services and fees
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
This instrument is the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020.
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
(1) In this instrument:
Act means the Health Insurance Act 1973.
amount under clause 2.1 has the meaning given by clause 2.1 of Part 2 of Schedule 2.
amount under clause 3.1 has the meaning given by clause 3.1 of Part 3 of Schedule 2.
amount under clause 3.2 has the meaning given by clause 3.2 of Part 3 of Schedule 2.
amount under clause 3.3 has the meaning given by clause 3.3 of Part 3 of Schedule 2.
non‑medicare service means a service provided by a nurse practitioner other than a service that is generally accepted in the nursing profession as being necessary for the appropriate treatment of the patient to whom it is rendered.
relevant provisions means all provisions, relating to professional services or medical services, of:
(a) the Act and regulations made under the Act; and
(b) the National Health Act 1953 and regulations made under that Act.
Note The following terms are defined in subsection 3(1) of the Act:
Note: general medical services table
Note: participating midwife
Note: participating nurse practitioner
Note: pathology services table
(2) Unless the contrary intention appears, a reference in this instrument 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.
Includes express scope controls: a nurse practitioner item only applies if the service is within that practitioner’s scope of practice (section 15). Several items also add competency or program membership requirements (for example item 73825 requires the practitioner to be part of the First Nations Molecular Point‑of‑Care Testing Program and to operate in Modified Monash 6 or 7 locations — section 20A).
Specifies how certain variable fees are to be calculated where a simple flat fee is not appropriate — e.g. definitions of “amount under clause 2.1” and “amount under clauses 3.1–3.3” that compute payable amounts as percentages of other fees or particular items (see Schedule 2 Parts 2 and 3 clauses 2.1, 3.1–3.3).
Provides an indexation rule to increase fees at a future date (1 July 2025) by a fixed multiplier and rounding protocol (section 6A).
Contains a short transitional rule allowing one midwifery item to be claimed in a limited period even if the usual antecedent attendances are missing (section 21).
Who this affects
Participating midwives and participating nurse practitioners: the instrument creates MBS claimability for a broad set of their services, subject to the instrument’s eligibility and documentation requirements (schedules and sections 10, 15–17).
General practices and organisations that engage nurse practitioners: some items require accreditation or program participation (e.g. point‑of‑care accreditation or membership in the First Nations PoC program — section 20A; accreditation for HbA1c point‑of‑care testing in item 73826).
Hospitals and hospital proprietors: the instrument distinguishes services provided while employed by a (non‑private) hospital and imposes limits where services are provided in hospital (see section 10(1)(b) and section 6B for (H) items).
Patients: the instrument determines when Medicare will pay benefits for care provided by midwives or nurse practitioners (attendance requirements, in‑attendance rule, caps, and limits). Patients must be physically present for most billable items (examples in sections 10(3) and 16(3)).
The Commonwealth budget (Medicare): by authorising MBS benefits for these services, the instrument creates direct cost exposure for Medicare equal to the fees and volumes of claims.
Why it matters (practical significance and mechanisms)
It formally extends Medicare payment treatment to a defined set of non‑medical practitioners’ services. That changes who can legally claim Medicare benefits for what services and sets the prices that will govern those claims (sections 8, 13, 14; Schedules 1 and 2).
It defines behaviour the provider must follow to receive payment: being a “participating” practitioner, providing a personal attendance with the patient in attendance, documenting attendance times or maternity care plans, having relevant accreditations or program memberships, and staying within scope of practice (sections 10, 15–17, item‑specific conditions in Schedules).
It creates substitution and deployment incentives: with MBS fees available for specified midwifery and nurse practitioner services, practices and organisations can structure care delivery (e.g. more midwife‑led antenatal care, nurse practitioner‑led point‑of‑care testing, NP assistance in theatre) knowing those services can attract Medicare benefits (see Schedules Group M13, M14, Group P9, Group M33).
It imposes compliance and administrative burdens on providers: many items require specific documentation (e.g. maternity care plan content, total attendance time in patient notes), and some require accreditation or formal program participation (sections 10(4), item 82115, section 20A, and item 73826 conditions). Those are preconditions for claiming.
Key implementation mechanics to note
Trade‑offs, incentives and risk points (light economic lens)
Who pays: Medicare (Commonwealth) pays benefits under the Act once the provider meets the item conditions (see sections 8, 13–14 and the Schedules). Providers receive the scheduled fee when the item rules are satisfied.
Concentrated benefits: the explicit fee schedule benefits participating midwives and nurse practitioners who meet the conditions (Schedules 1 and 2). The beneficiaries are relatively concentrated (practitioners authorised to claim), while costs (Medicare expenditure) are dispersed across taxpayers.
Substitution effects: concrete mechanisms enable substitution of some services that GPs or specialists previously delivered — e.g. some pathology point‑of‑care tests and procedural contraceptive services now attract NP items (Schedule 2 Group P9 and Group M14). That may change who delivers front‑line care in certain settings.
Compliance and administrative cost: the instrument requires documentation (patient notes, maternity care plan contents, proof of program competency), accreditation or program participation for some items, and adherence to scope‑of‑practice limits — these raise compliance costs for providers and administrative costs for Medicare in assessing claims (sections 10, 15, 20A; item descriptors).
Implementation risk / clinical safety controls: scope‑of‑practice clauses and conditions (section 15) and hospital‑only markings (6B) place some clinical gatekeeping into the instrument. Several items are limited to accredited settings or specific clinical contexts (e.g. Modified Monash remote areas for item 73825), which is an implementation control but requires administrative oversight.
Opportunities and capture‑risk observation (mechanism, not judgement): the instrument establishes new, billable niches (telehealth support, PoC testing, assistance at operations). Where fees are attractive relative to alternative billing routes there is an incentive for practitioners and organisations to organise care to generate these items — that is a predictable economic response to fee schedules and is implemented through the specific item‑level rules (see video support items 82250–82257 and PoC program item 73825).
Relevant sections to check quickly
(If you want, I can extract the precise claim conditions and documentation checklist for a particular item number — e.g. item 82115 (maternity care plan) or item 73825 (First Nations PoC test) — into a short one‑page checklist.)
(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:
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 a Schedule of this Determination, other than the fee for the following:
(a) an item in Group P9.
(3) 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).
(1) An item in this instrument including the symbol (H) applies only to a service performed or provided in a hospital.
Part 2 Midwifery services
(1) In this Part:
birth includes episiotomy and repair of tears.
(2) For this Part, a participating midwife is a member of a practice that provides a patient’s antenatal care if the midwife:
(a) participates (whether as a partner, employee or otherwise) in the provision of professional services as part of the practice; or
(b) provides relief services to the practice; or
(c) provides professional services as part of the practice as a locum.
For subsection 3C(1) of the Act, a midwifery service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Schedule 1 for the service.
(1) An item in Schedule 1 applies to a service only if:
(a) the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating midwife; and
(b) the midwife:
(i) is not employed by the proprietor of a hospital that is not a private hospital; or
(ii) both:
(A) is employed by the proprietor of a hospital that is not a private hospital; and
(B) provides the service otherwise than in the course of employment by that proprietor.
(2) Subsection (1) applies whether or not another person provides essential assistance to the participating midwife in accordance with accepted clinical practice.
(3) An item in Schedule 1 does not apply to a service provided for a patient if the patient is not in attendance.
Examples — patient not in attendance
1 Completing patient records.
2 Issuing repeat prescriptions.
3 Telephone attendances.
(4) In items 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1:
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.
(5) 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 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
(6) If a service described in item 82103 is provided on the same day as a service to which item 82100, 82102, 82105, 82110, 91211, 91212, 91218 or 91219 applies, the subsequent item will only apply if it is:
(a) not a continuation of the first attendance; and
(b) is clinically relevant and distinct from the first attendance.
(1) Items 82116, 82118, 82120, 82123, 82125 and 82127 in Part 1 of Schedule 1 apply only to a service provided by a participating midwife during a period of exclusive care of a patient in labour.
(2) Items 82116, 82118, 82120, 82123, 82125 and 82127 in Part 1 of Schedule 1 do not apply if, before labour, the patient’s care is transferred to an obstetrician or medical practitioner who provides obstetric services, for the obstetrician or practitioner to manage the labour and birth.
(3) Items 82118 and 82120 in Part 1 of Schedule 1 applies to a service provided by a participating midwife (the first midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the first midwife to another participating midwife in order to manage fatigue experienced by the first midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
(4) Items 82123 and 82125 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the second midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the second midwife to another participating midwife in order to manage fatigue experienced by the second midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
(5) Item 82127 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the third midwife) who manages a patient’s labour, but does not undertake the birth, only if:
(a) the patient’s care was transferred from the third midwife to another participating midwife to manage fatigue experienced by the third midwife; or
(b) there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.
Part 3 Nurse practitioner services
Subject to section 14, for subsection 3C(1) of the Act, a nurse practitioner service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Schedule 2 relating to the service.
For subsection 3C(1) of the Act, a nurse practitioner service described in Part 1 of Schedule 2 provided in accordance with this instrument is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the pathology services table that:
(i) related to the service; and
(ii) mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Part 1 of Schedule 2 relating to the service.
Note 1 A participating nurse practitioner performing a service described in items 73828 to 73837 must be the patient’s treating practitioner in order for medicare benefit to be payable — see subsection 16A(7A) of the Act.
(1) For a patient, an item in Schedule 2 applies only if the service mentioned in that item is within the scope of practice of the participating nurse practitioner who provides the service.
(1) An item in Schedule 2, except an item in Part 1 of Schedule 2, applies to a service only if:
(a) the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating nurse practitioner; and
(b) the nurse practitioner:
(i) is not employed by the proprietor of a hospital that is not a private hospital; or
(ii) both:
(A) is employed by the proprietor of a hospital that is not a private hospital; and
(B) provides the service otherwise than in the course of employment by that proprietor.
(2) Subsection (1) applies whether or not another person provides essential assistance to the participating nurse practitioner in accordance with accepted clinical practice.
(3) An item in Schedule 2, except an item in Part 1 of Schedule 2, does not apply to a service provided for a patient if the patient is not in attendance.
Examples — patient not in attendance
1 Completing patient records.
2 Issuing repeat prescriptions.
3 Telephone attendances.
(4) In Part 2 of Schedule 2:
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.
(5) 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 Part 2 of Schedule 2; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
(6) Items 82200, 82205, 82210 and 82215 do not apply to a service described in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.
An item in Part 1 of Schedule 2 applies to a service only if the participating nurse practitioner who renders the service:
(a) is not employed by the proprietor of a hospital that is not a private hospital; or
(b) both:
(i) is employed by the proprietor of a hospital that is not a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
Section 7 of the Health Insurance (Prescribed Pathology Services) Determination 2021 shall have effect as if the services specified in items 73826 to 73837 of Schedule 2 Part 1 were also specified in that section.
Item 73826 does not apply to a service provided to a patient who has already been provided, in the last 12 months, 4 other services to which any of the following apply:
(a) item 73826;
(b) item 66551;
(c) item 73812.
(1) Item 73825 applies to a service only if:
(a) the service is rendered at, or from, a practice location in:
(i) a Modified Monash 6 area; or
(ii) a Modified Monash 7 area;
(b) the nurse practitioner providing the service:
(i) is employed by an organisation that:
(A) delivers health services; and
(B) is participating in the First Nations Molecular Point‑of‑Care (PoC) Testing Program;
(c) the service is provided in accordance with the Program referred to in subparagraph (b)(i)(B);
(d) the service is conducted by a nurse practitioner who has achieved competency as a PoC operator by the First Nations Molecular PoC Testing Program for the test(s) performed; and
(e) the PoC test(s) gives valid patient result(s).
Part 4 Transitional provisions
(1) Between 1 March 2022 and 31 August 2022, item 82115 will apply to a service provided to a patient where the participating midwife has not had at least 2 antenatal attendances with the patient in the 6 months prior to the service provided to the patient.
Schedule 1 Midwifery services and fees
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This is an opening excerpt, not the complete document.