1 Name of Determination
This Determination is the Health Insurance (Allied Health Services) Determination 2014.
4 Interpretation
(1) In this Determination:
Act means the Health Insurance Act 1973.
admitted patient means a patient who is receiving a service that is provided:
(a) as part of an episode of hospital treatment; or
(b) as part of an episode of hospital‑substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.
allied health professional, for the provision of an allied health service, means a person:
(a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and
(b) whose name is entered in the register, kept by the Chief Executive Medicare, of allied health professionals who are qualified to provide a service of that kind.
Note: Allied health professionals in relation to the provision of a focussed psychological strategies health service are subject to the requirements of section 10.
allied health service means:
(a) a health service of a kind prescribed by section 12 of the Health Insurance Regulations 2018; or
(b) a health service that is an optometry treatment service;
that is specified in an item in Schedule 2.
course of assessment means:
(a) for complex neurodevelopmental disorder services—up to 4 services to which any of items 82000, 82005, 82010, 82030 or items 93032, 93033, 93040 and 93041 of the COVID‑19 Determination applies provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist; or
(vii) an eligible speech pathologist; or
(b) for disability services—up to 4 services to which any of items 82000, 82005, 82010, 82030 or items 93032, 93033, 93040 and 93041 of the COVID‑19 Determination applies provided, on referral by a specialist or consultant physician practising in the practice of his or her field of specialty or a general practitioner, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist; or
(vii) an eligible speech pathologist.
course of treatment means:
(a) for psychological therapy and focussed psychological strategies—up to 6 services to which any of items 80000, 80002, 80005, 80006, 80010, 80012, 80015, 80016, 80100, 80102, 80105, 80106, 80110, 80112, 80115, 80116, 80125, 80129, 80130, 80131, 80135, 80137, 80140, 80141, 80150, 80154, 80155, 80156, 80160, 80162, 80165 or 80166 or items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204 or 91205 of the COVID‑19 Determination applies, provided on referral by a medical practitioner, by any of the following persons:
(i) an eligible clinical psychologist;
(ii) an eligible psychologist;
(iii) an eligible occupational therapist;
(iv) an eligible social worker; or
(b) for complex neurodevelopmental disorder services—up to 10 treatment services to which any of items 82015, 82020, 82025, 82035 or items 93035, 93036, 93043 and 93044 of the COVID‑19 Determination applies provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist;
(vii) an eligible speech pathologist; or
(c) for disability services—up to 10 treatment services to which any of items 82015, 82020, 82025, 82035 or items 93035, 93036, 93043 and 93044 of the COVID‑19 Determination applies provided, on referral by a specialist or consultant physician specialising in the practice of his or her field of specialty, or a general practitioner, by any of the following persons:
(i) an eligible audiologist;
(ii) an eligible occupational therapist;
(iii) an eligible optometrist;
(iv) an eligible orthoptist;
(v) an eligible physiotherapist;
(vi) an eligible psychologist;
(vii) an eligible speech pathologist.
COVID‑19 Determination means the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021
CPD year means the period of time in which focussed psychological strategies continuing professional development must be completed being from 1 July to 30 June annually.
eating disorder dietetic treatment service means a service to which any of items 10954 or 82350, or items 93074 or 93108 of the COVID‑19 Determination applies.
eating disorder treatment and management plan has the same meaning as in the general medical services table.
eligible Aboriginal and Torres Strait Islander health practitioner means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 1 of item 1 of Schedule 1 of this Determination.
eligible Aboriginal health worker means a person who:
(a) is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 2 of item 1 of Schedule 1 of this Determination; and
(b) is not providing an Aboriginal and Torres Strait Islander health service in the Northern Territory.
eligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.
eligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.
eligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.
eligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.
eligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.
eligible disability means any of the following:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(c) deafblindness;
(d) cerebral palsy;
(e) Down syndrome;
(f) Fragile X syndrome;
(g) Prader‑Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith‑Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex, and
(ii) a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence;
(p) Rett’s disorder.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) an occupational therapy health service.
eligible optometrist means a person who is an allied health professional in relation to the provision of an optometry health service.
eligible orthoptist means a person who is an allied health professional in relation to the provision of an orthoptic health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy that involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy;
(ea) eye movement desensitisation and reprocessing;
(f) narrative therapy (for Aboriginal and Torres Strait Islander people).
focussed psychological strategies continuing professional development means the completion of 10 continuing professional development units per CPD year, each unit being 1 hour that relate to the delivery of focussed psychological strategies in any of the following areas:
(a) psycho‑education;
(b) cognitive‑behavioural therapy including;
(i) behavioural interventions;
(ii) behaviour modification;
(iii) exposure techniques;
(iv) activity scheduling;
(c) cognitive interventions including:
(i) cognitive therapy;
(d) relaxation strategies including;
(i) progressive muscle relaxation;
(ii) controlled breathing;
(e) skills training including;
(i) problem solving skills and training;
(ii) anger management;
(iii) social skills training;
(iv) communication training;
(v) stress management;
(vi) parent management training;
(f) interpersonal therapy;
(fa) eye movement desensitisation and reprocessing;
(g) narrative therapy (for Aboriginal and Torres Strait Islander people);
(h) clinical skills to undertake a full assessment of a patient in order to form a diagnosis and commence treatment planning.
GP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the general medical services table, or item 92024, 92028, 92068, 92072, 92055, 92059, 92099 or 92103 of the COVID‑19 Determination or item 229 or 233 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.
GP Mental Health Treatment Plan, for a patient, means a GP Mental Health Treatment Plan for the patient to which item 2700, 2701, 2715 or 2717 of the general medical services table applies, or item 272, 276, 281 or 282 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018, or item 92112, 92113, 92116, 92117, 92118, 92119, 92122, 92123, 92124, 92125, 92128, 92129, 92130, 92131, 92134 or 92135 of the COVID‑19 Determination applies.
Health Care Homes Program means the program of that name administered by the Department of Health.
Health Care Homes trial site means a medical practice:
(a) in respect of which a grant was made by the Commonwealth under the Health Care Homes Grant Program; and
(b) that is participating in the Health Care Homes Program.
mental disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:
(a) may require medical intervention;
(b) may be a recognised, medically diagnosable illness or disorder; and
(c) is not dementia, delirium, tobacco use disorder or mental retardation.
multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 729 or 731 of the general medical services table, or item 92026, 92027, 92070, 92071, 92057, 92058, 92101 or 92102 of the COVID‑19 Determination or item 231 or 232 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.
National Law means:
(a) for a State or Territory other than Western Australia—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and
(b) for Western Australia—the legislation enacted by the Health Practitioner Regulation National Law(WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
Occupational Therapy Australia means the national body of the Australian Association of Occupational Therapists.
Psychology Board of Australia means that body established under section 31 of the National Law.
registered training organisation means a training provider registered under a law of a State, Territory or the Commonwealth to provide accredited vocational education and training.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.
Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or 732 of the general medical services table, or item 92025, 92028, 92069, 92072, 92056, 92059, 92100 or 92103 of the COVID‑19 Determination, or item 230 or 233 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.
telehealth eligible area has the meaning given by section 6D.
Note: The following terms are defined in subsection 3(1) of the Act:
dental practitioner
general medical services table
item
medical practitioner
Chief Executive Medicare
optometrist
professional service.
(2) A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a person, who is currently pregnant or who has been pregnant in the preceding 12 months, by a health professional in which:
(a) information and issues relating to pregnancy are discussed; but
(b) the health professional does not impose his or her views or values about what the person should or should not do in relation to the pregnancy.
5 Treatment of allied health services
An allied health service provided in accordance with this Determination 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) specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.
Note: For this Determination, an internal Territory is deemed to form part of the State of New South Wales—see subsection 3C(7) of the Act.
6 Limitation on certain individual items
(1) This section applies to items 80000, 80002, 80005, 80006, 80010, 80012, 80015, 80016, 80100, 80102, 80105, 80106, 80110, 80112, 80115, 80116, 80125, 80129, 80130, 80131, 80135, 80137, 80140, 80141, 80150, 80154, 80155, 80156, 80160, 80162, 80165 and 80166 in Schedule 2.
(3) For any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient, or to a person other than the patient as part of the patient’s treatment, in the calendar year.
(4) In this section, relevant service means a service to which any of items 283, 285, 286, 287, 309, 311, 313 or 315 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 or 2721 to 2727, 2739, 2741, 2743 or 2745 of the general medical services table, or items 80000 to 80016, 80100 to 80116, 80125 to 80141, or 80150 to 80166 in Schedule 2, or items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 of the COVID‑19 Determination apply.
(5) In addition to the restrictions in subclause (3) of this section, item 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162 or 80166 applies to a service provided to a person other than the patient only if:
(a) the referring practitioner or the eligible practitioner providing the service determines it is clinically appropriate to provide services to a person other than the patient, and makes a written record of this determination in the patient’s records; and
(b) the eligible practitioner providing the service to a person other than the patient:
(i) explains the service to the patient; and
(ii) obtains the patient’s consent for the service to be provided to the other person as part of the patient’s treatment; and
(iii) makes a written record of the consent; and
(c) the service is provided as part of the patient’s treatment; and
(d) the patient is not in attendance during the provision of the service; and
(e) in the calendar year, no more than one other service to which any of items 309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 apply has already been provided to or in relation to the patient.
Note: The patient’s consent may be withdrawn at any time.
6A Limitation on certain group items
(1) For any particular patient, an item mentioned in subsection (2) applies in a calendar year only if the service described in the item is one of the first 10 services mentioned in items in subsection (2) provided to the patient in the calendar year.
(2) The items are items 80020, 80021, 80022, 80023, 80024, 80025, 80120, 80121, 80122, 80123, 80127, 80128, 80145, 80146, 80147, 80148, 80152, 80153, 80170, 80171, 80172, 80173, 80174 and 80175 in Schedule 2.
(3) An item listed in subsection (2) does not apply if the mental health treatment plan was provided under items 93400 to 93411 and 93431 to 93442 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020.
(4) An item listed in subsection (2) may apply to a service where only three patients attend if:
(a) four patients were due to attend; and
(b) one of the patients is unable to attend.
6AA Limitations on eating disorders items
(1) For an item in Subgroup 2 of Part 8 of Schedule 2, the service must involve the provision of any of the following mental health care management strategies:
(a) family based treatment (including whole family, parent based therapy, parent only or separated therapy)
(b) adolescent focused therapy;
(c) cognitive behavioural therapy;
(d) cognitive behavioural therapy‑anorexia nervosa;
(e) cognitive behavioural therapy for bulimia nervosa and binge‑eating disorder;
(f) specialist supportive clinical management;
(g) maudsley model of anorexia treatment in adults;
(h) interpersonal therapy for bulimia nervosa and binge‑eating disorder;
(i) dialectical behavioural therapy for bulimia nervosa and binge‑eating disorder;
(j) focal psychodynamic therapy.
(2) An item in Subgroup 2 of Part 8 of Schedule 2 does not apply to a service providing a treatment to a patient under an eating disorder treatment and management plan if:
(a) the service is provided more than 12 months after the plan is prepared; or
(b) the patient has already been provided with 40 services under the plan; or
(c) the service is provided after the patient has already been provided with 10 services under the plan but before a recommendation by a reviewing practitioner is given that additional services should be provided under the plan; or
(d) the service is provided after the patient has already been provided with 20 services under the plan but before recommendations that additional services should be provided under the plan are given by each of the following:
(i) a medical practitioner (other than a specialist or consultant physician);
(ii) a consultant physician practising in the specialty of psychiatry or paediatrics; or
(e) the service is provided after the patient has already been provided with 30 services under the plan but before a recommendation is given by a reviewing practitioner that additional services should be provided.
(3) A reviewing practitioner may recommend that additional services be provided under a plan only if:
(a) the recommendation is made as part of a service to which an item in Subgroup 3 of Group A36 of the general medical services table or Subgroup 25 or 26 of Group A40 of the COVID‑19 Determination applies; and
(b) the service is provided:
(i) for the purposes of paragraph (2)(c)—after the patient has been provided with 10 services under the plan; and
(ii) for the purposes of paragraph (2)(d)—after the patient has been provided with 20 services under the plan; and
(iii) for the purposes of paragraph (2)(e)—after the patient has been provided with 30 services under the plan; and
(c) the practitioner records the recommendation in the patient’s records.
(3C) For the purposes of this clause, in counting the services providing treatments under a plan, only count the services to which any of the following apply:
(a) items 283, 285, 286, 287, 309, 311, 313, 315, 371 and 372;
(b) items 2721, 2723, 2725, 2727, 2739, 2741, 2743 and 2745;
(c) items in Groups M6, M7 and M16 other than item 82350;
(d) items 90271, 90272, 90273, 90274, 90275, 90276, 90277 and 90278;
(e) items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181 to 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866, 91867, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 93076, 93079, 93084. 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134 and 93137.
(4) For any particular patient, an item in Subgroup 1 of Part 8 in Schedule 2 does not apply if the patient has had 20 eating disorder dietetic treatment services in a 12 month period commencing from the provision of an eating disorder treatment and management plan.
(5) For an item in Subgroup 2 of Part 8 of Schedule 2, a patient is an eligible patient if the patient meets the requirements for a patient specified in clause 2.31.2 of the general medical services table.
6AB Reporting requirement for eating disorders items
(1) For an item in Part 8 of Schedule 2, the relevant allied health professional must provide the referring medical practitioner with a written report on assessments carried out, treatment provided and recommendations for future management of the patient’s condition at required intervals.
(2) A report under subsection (1) is to be provided:
(a) after the first service;
(b) as clinically required following subsequent services; and
(c) after the final service.
6AC Limitation on certain individual telehealth items
(1) This section applies to items 82359, 82367, 82375 and 82383.
(2) An item mentioned in subsection (1) does not apply to a service if the patient or the allied health professional has travelled to a place to satisfy the requirement that the patient be a distance of at least 15 km by road from the allied health professional.
6C Limitation on certain group telehealth items
(1) This section applies to items 80021, 80023, 80025, 80121, 80123, 80128, 80146, 80148, 80153, 80171, 80173 and 80175 in Schedule 2.
(2) For any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient in the calendar year.
(3) An item mentioned in subsection (1) does not apply to a service if the patient or the allied health professional has travelled to a place to satisfy the requirement in paragraph (e) of the item.
(4) In this section relevant service means a service to which any of items 80020, 80021, 80022, 80023, 80024, 80025, 80120, 80121, 80122, 80123, 80127, 80128, 80145, 80146, 80147, 80148, 80152, 80153, 80170, 80171, 80172, 80173, 80174 and 80175 in Schedule 2, apply.
6D Telehealth eligible areas
(1) A telehealth eligible area means an area within:
(a) Modified Monash area 4, being all areas categorised as ASGS‑RA 2 or ASGS‑RA 3 under the ASGS that are not in Modified Monash areas 2 or 3, and are in, or within 10 kilometre road distance of, a town with population between 5,000 and 15,000; or
(b) Modified Monash area 5, being all areas categorised as ASGS‑RA 2 or ASGS‑RA 3 under the ASGS that are not in Modified Monash areas 2, 3 or 4; or
(c) Modified Monash area 6, being all areas categorised as ASGS‑RA 4 under the ASGS that are not on a populated island that is separated from the mainland in the Australian Bureau of Statistics geography and is more than 5 kilometres offshore; or
(d) Modified Monash area 7, being all areas categorised as ASGS‑RA 5 under the ASGS and areas on a populated island that is separated from the mainland in the Australian Bureau of Statistics geography and is more than 5 kilometres offshore.
(2) In this section:
(a) ASGS means the July 2016 edition of the Australian Statistical Geography Standard, published by the Australian Bureau of Statistics, as existing on 1 January 2020;
(b) Modified Monash area 2 means areas categorised as ASGS‑RA 2 or ASGS‑RA 3 under the ASGS that are in, or within 20 kilometres road distance of, a town with population >50,000; and
(c) Modified Monash area 3 means areas categorised as ASGS‑RA 2 or ASGS‑RA 3 under the ASGS that are not in Modified Monash area 2 and are in, or within 15 kilometres road distance of, a town with population between 15,001 and 50,000.
Note 1: The ASGS can be viewed on the Australian Bureau of Statistics’ website (https://www.abs.gov.au).
Note 2: The Modified Monash Model is a geographical classification system developed by the Department for categorising metropolitan, regional, rural and remote locations according to both geographical remoteness and population size, based on population data published by the Australian Bureau of Statistics.
Maps of the Modified Monash Model areas and the Department’s remoteness classification can be viewed at www.doctorconnect.gov.au.
6E Psychological therapy and focussed psychological strategies health services provided to a person other than the patient
(1) For the purposes of items 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162 and 80166, referring practitioner means:
(a) a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan or psychiatrist assessment and management plan; or
(b) a specialist or consultant physician specialising in the practice of their field of psychiatry; or
(c) a specialist or consultant physician specialising in the practice of their field of paediatrics.
7 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
(1) This section applies to items 80000 to 80175 in Schedule 2.
(2) The referral by a consultant physician specialising in the practice of the consultant physician’s field of psychiatry must be a referral for a service to which any of items 293 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92436, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID‑19 Determination applies.
(3) The referral by a consultant physician specialising in the practice of the consultant physician’s field of paediatrics must be a referral for a service to which any of items 110 to 133 of the general medical services table or items 91824, 91825, 91826, 91836, 92422 or 92423 of the COVID‑19 Determination applies.
(4) The referral by a specialist in the practice of the specialist’s field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the general medical services table or items 91822, 91823 or 91833 of the COVID‑19 Determination applies.
8 Referrals by psychiatrists and paediatricians for complex neurodevelopmental disorder and disability services
(1) This section applies to items 82000 to 82035 in Schedule 2.
(2) For items 82000, 82005, 82010 and 82030 the referral by a consultant physician specialising in the practice of the consultant physician’s field of psychiatry must be a referral for a service to which any of items 296 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID‑19 Determination applies.
(3) For items 82000, 82005, 82010 and 82030 the referral by a consultant physician specialising in the practice of the consultant physician’s field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table or items 91824, 91825, 91826 or 91836 of the COVID‑19 Determination applies.
(4) For items 82015, 82020, 82025 and 82035 the referral by a consultant physician specialising in the practice of the consultant physician’s field of psychiatry must be a referral for a service to which item 289 of the general medical services table or item 92434 of the COVID‑19 Determination applies.
(5) If a patient has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of the consultant physician’s field of psychiatry may only refer the patient for a service to which any of items 296 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID‑19 Determination applies.
(6) For items 82015, 82020, 82025 and 82035 the referral by a consultant physician specialising in the practice of the consultant physician’s field of paediatrics must be a referral for a service to which item 135 of the general medical services table or item 92140 of the COVID‑19 Determination applies.
(7) If a patient has previously been provided with a service mentioned in item 135 of the general medical services table or item 92140 of the COVID‑19 Determination, a consultant physician specialising in the practice of the consultant physician’s field of paediatrics may only refer the patient for a service to which any of items 110 to 131 of the general medical services table or items 91824, 91825, 91826 or 91836 of the COVID‑19 Determination applies.
(8) If a patient has previously been provided with a service mentioned in item 137 or 139 of the general medical services table or item 92141 or 92142 of the COVID‑19 Determination, the medical practitioner cannot refer the patient for a service to which item 135 or 289 of the general medical services table or item 92140 or 92434 of the COVID‑19 Determination applies.
8A Referrals by specialists, consultant physicians and general practitioners for disability services
(1) This section applies to items 82000 to 82035 in Schedule 2.
(2) For items 82000, 82005, 82010 and 82030 the referral by a specialist or consultant physician specialising in the practice of their field of speciality must be a referral for a service to which any of items 104 to 131, 296 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91822 to 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID‑19 Determination applies.
(3) For items 82000, 82005, 82010 and 82030 the referral by a general practitioner must be a referral for a service to which any of items 3 to 47 of the general medical services table or item 91790, 91800, 91801, 91802, 91890, 91891 or 91894 of the COVID‑19 Determination applies.
(4) For items 82015, 82020, 82025 and 82035 the referral by a specialist or consultant physician specialising in the practice of their field of speciality must be a referral for a service to which item 137 of the general medical services table or item 92141 of the COVID‑19 Determination applies.
(5) For items 82015, 82020, 82025 and 82035 the referral by a general practitioner must be a referral for a service to which item 139 of the general medical services table or item 92142 of the COVID‑19 Determination applies.
(6) If a patient has previously been provided with a service mentioned in item 135 or 289 of the general medical services table or item 92140 or 92434 of the COVID‑19 Determination, the medical practitioner cannot refer the patient for a service to which item 137 or 139 of the general medical services table or item 92141 or 92142 of the COVID‑19 Determination applies.
8AA Application of items for complex neurodevelopmental disorder and disability services
(1) This section applies to items 82000, 82005, 82010, 82015, 82020, 82025, 82030 and 82035 in Schedule 2.
(2) For the purposes of an item mentioned in subsection (1) of this section, eligible medical practitioner means:
(a) for a patient with a confirmed, or suspected, complex neurodevelopmental disorder (such as autism spectrum disorder), a consultant physician specialising in the practice of their field of psychiatry or paediatrics; or
(b) for a patient with a confirmed, or suspected, eligible disability, a specialist or consultant physician practising in their specialty, or a general practitioner.
(3) For the purposes of an item mentioned in subsection (1) of this section, treatment and management plan means:
(a) for a patient with a confirmed complex neurodevelopmental disorder (such as autism spectrum disorder), a plan for the treatment and management of the patient’s complex neurodevelopmental disorder to which item 135 or 289 of the general medical services table, or item 92140 or 92434 of the COVID‑19 Determination applies; or
(b) for a patient with a confirmed eligible disability, a plan for the treatment and management of the patient’s eligible disability to which any of items 137 or 139 of the general medical services table or items 92141 or 92142 of the COVID‑19 Determination applies.
(4) An item mentioned in subsection (1) will only apply to a service if the eligible allied health practitioner providing the service meets the credentialing requirements for the provision of a complex neurodevelopmental disorder or disability service.
(5) For a service to which item 82000, 82005, 82010 or 82030 applies, the patient must be referred to the eligible allied health practitioner (the providing allied health practitioner) by:
(a) an eligible medical practitioner; or
(b) an eligible allied health practitioner (the referring allied health practitioner), if:
(i) the patient was referred to the referring allied health practitioner by an eligible medical practitioner;
(ii) the referral from the medical practitioner to the referring allied health practitioner is valid;
(iii) the eligible medical practitioner has been consulted and agreed to the referral of the patient to the providing allied health practitioner; and
(iv) the referring allied health practitioner has documented the eligible medical practitioner’s agreement in the patient’s notes.
(6) A service described in item 82000, 82005, 82010 or 82030 will only apply to a service provided to a patient if in the patient’s lifetime the patient has been provided less than 8 other services to which any of items 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041 apply.
(7) For the purposes of subsection (6) of this section, if a patient has been provided 4 services to which any of items 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041 apply by the same eligible allied health practitioner under a single referral, before any of the remaining 4 services may be provided by the same allied health practitioner under the same referral:
(a) the eligible allied health practitioner providing the service must request the provision of additional services from the eligible medical practitioner who initially referred the patient;
(b) the eligible medical practitioner must review the eligible allied health practitioner’s request for the provision of further services and agree to the additional services; and
(c) the eligible allied health practitioner must make a record of the eligible medical practitioner’s agreement in the patient’s notes.
(8) A service described in item 82015, 82020, 82025 or 82035 will only apply to a service provided to a patient if in the patient’s lifetime the patient has been provided less than 20 services to which any of items 82015, 82020, 82025, 82035, 93035, 93036, 93043 or 93044 apply.
8B Referrals by medical practitioners for eating disorder allied health treatment services
(1) This section applies to items in Part 8 of Schedule 2.
(2) For any particular patient, an item in Part 8 of Schedule 2 does not apply unless the patient has been referred by:
(a) a general practitioner or medical practitioner who issued the referral as part of a service to which an item in Subgroup 1 of Group A36 of the general medical services table or item 92146, 92147, 92148, 92149, 92150, 92151, 92152. 92153, 92154, 92155, 92156, 92157, 92158, 92159, 92160 or 92161 of the COVID‑19 Determination applies; or
(b) a consultant physician in the specialty of psychiatry or paediatrics who issued the referral as part of a service to which an item in Subgroup 2 of Group A36 of the general medical services table or item 92162, 92163, 92166 or 92167 applies; or
(c) a medical practitioner who issued the referral as part of a service to which an item in Subgroup 3 of Group A36 of the general medical services table or item 92170 to 92173 or 92176 to 92179, of the COVID‑19 Determination applies.
9 Effect of election to claim private health insurance for an allied health service
An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.
9A Complex neurodevelopmental disorder and disability services course of assessment—reporting requirements
(1) This section applies to items 82000, 82005, 82010 and 82030.
(2) At the completion of a course of assessment, the allied health professional must provide a written report to the medical practitioner who initially referred the patient.
10 Focussed Psychological Strategies health services
(1) A person to whom subsection (1A) applies must complete focussed psychological strategies continuing professional development each CPD year.
(1A) This subsection applies to a person who:
(a) is an allied health professional in relation to the provision of a focussed psychological strategies health service; and
(b) is not a general registrant psychologist.
(2) A person required to complete focussed psychological strategies continuing professional development must keep written records of completion of focussed psychological strategies continuing professional development for a period of two years from the end of the CPD year to which the focussed psychological strategies continuing professional development relates.
(4) Other than where subsection (7) applies, where a person who is not a general registrant psychologist seeks to become an allied health professional in relation to the provision of a focussed psychological strategies health service during a CPD year and meets the qualification requirements set out in Schedule 1 for the provision of a focussed psychological strategies health service:
(a) that person’s name will be entered on the register; and
(b) that person will have until the end of that CPD year to meet their focussed psychological strategies continuing professional development requirements on a pro‑rata basis, with units being calculated from the first day of the month immediately succeeding the date of registration.
(5) If the Minister is satisfied that a person referred to in subsection (1) has not completed their focussed psychological strategies continuing professional development, the Minister:
(a) may decide to remove the name of that person from the register; and then
(b) notify the Chief Executive Medicare to remove the name from the register.
(6) Before the Minister provides notification under paragraph (5)(b), the Minister must notify that person in writing of the decision setting out:
(a) the decision;
(b) the reasons for the decision; and
(c) a statement of the person’s reconsideration rights under section 11.
(7) If the name of a person has been removed from the register under subsection (9), in order to become an allied health professional in relation to the provision of a focussed psychological strategies health service (reregistered) that person must apply to be registered and in his or her application must:
(a) provide evidence of attaining the necessary amount of units that he or she was required to attain to comply with the focussed psychological strategies continuing professional development in the CPD year in which he or she failed to comply;
and if reregistered must
(b) comply with subsection (1) as if the CPD year in which he or she was reregistered commenced on the date of reregistration.
(8) The Minister may grant an exemption in whole or part from focussed psychological strategies continuing professional development, where:
(a) a written application from an allied health professional has been received; and
(b) the Minister is satisfied that special circumstances prevented or will prevent the allied health professional from completing focussed psychological strategies continuing professional development in a CPD year.
(9) Upon receiving notification under paragraph (5)(b), the Chief Executive Medicare must not remove the name of an allied health professional from the register until notified:
(a) under subsection 11(10) that the Minister has given notice to the allied health professional:
(i) under subsection 11(5) that the decision to remove the name of the person from the register has been affirmed; or
(ii) under subsection 11(9)(c); or
(b) that such period of time as referred to in subsection 11(2) has expired and the allied health professional has not applied for reconsideration under subsection 11(1) or requested further time under subsection 11(6).
(10) For the avoidance of doubt, nothing in this section:
(a) prevents the Chief Executive Medicare from including the name of a general registrant psychologist on the register; or
(b) requires the Chief Executive Medicare to remove the name of a general registrant psychologist from the register.
general registrant psychologist means a person who holds general registration in the health profession of psychology under the applicable law in force in the State or Territory in which the service is provided; and
register means the register kept by the Chief Executive Medicare of allied health professionals who are qualified to provide a focussed psychological strategies health service.
11 Reconsideration of Decision
(1) Where the Minister has provided notification under section 10(6), the allied health professional may apply to the Minister for reconsideration of that decision.
(2) The application must be made in writing:
(a) within 28 days from the date of the decision; or
(b) if the Minister is satisfied that special circumstances exist, within such further period as the Minister, before the expiration of the period referred to in paragraph (a), allows.
(3) The allied health professional must set out the reasons for the application and in doing so, may provide new material for the Minister to consider.
(4) The Minister must, within 28 days after receipt of an application made in accordance with subsection (1), reconsider the decision and make a new decision either:
(a) affirming the decision; or
(b) setting aside the decision.
(5) The Minister must give the allied health professional notice in writing of the reconsideration decision setting out:
(a) the decision; and
(b) the reasons for the decision.
(6) The allied health professional may, as an alternative to applying for reconsideration of the decision, request further time to complete the number of units required to satisfy the Minister that the allied health professional complies with section 10(1).
(7) If the allied health professional makes a request for further time under subsection (6) that request takes the place of the right to reconsideration under subsection (1).
(8) If the allied health professional makes a request under subsection (6), the period of time in which to complete the number of units required to satisfy the Minister is 28 days, commencing from the date of notification by the Minister that the allied health professional may complete the nominated amount of units.
(9) If, by the end of the period of time referred to in subsection (8), the Minister is not satisfied that the allied health professional has completed the amount of units required to comply with section 10(1), the Minister must:
(a) proceed as if the allied health professional had applied under subsection (1);
(b) make a decision, which will be regarded as being made under subsection (4); and
(c) give the allied health professional notice in writing of the decision as if the notice was given under subsection (5).
(10) The Minister must provide a written copy of a decision made under this section to the Chief Executive Medicare.
12 Requests for diagnostic audiology services
(1) This section applies to items 82300 to 82332 (other than item 82301) in Schedule 2.
(2) The request must be in writing and must contain:
(a) the date of the request; and
(b) the name of the eligible practitioner who requested the service and either the address of his or her place of practice or the provider number in respect of his or her place of practice; and
(c) a description of the service which provides sufficient information to identify the service as relating to a particular item mentioned in subsection (1) but need not specify the item number.
(3) A request may be for the performance of more than one diagnostic audiology service making up a single audiological assessment but cannot be for more than one audiological assessment.
14 Application of case conference items generally
(1) This Section applies to items 10955, 10957, 10959, 80176, 80177, 80178, 82001, 82002 and 82003 in Schedule 2.
(2) For the purposes of an item mentioned in subsection (1):
(a) community case conference has the meaning given by clause 7.1.1 of the general medical services table;
(b) multidisciplinary case conference has the meaning given by clause 1.1.4 of the general medical services table;
(c) multidisciplinary case conference team has the meaning given by clause 1.1.5 of the general medical services table as if the items were also specified in subparagraph 1.1.5(1)(b)(i);
(d) participate has the meaning given by clause 2.16.16 of the general medical services table; and
(e) mental health case conference has the meaning given by clause 7.1.1 of the general medical services table.
Patient and multidisciplinary case conference team member attendance requirements
(3) An item mentioned in subsection (1) may apply to a service provided for a patient if the patient is not in attendance.
(4) An item mentioned in subsection (1) does not apply to a service if the minimum number of members of the multidisciplinary case conference team are not in attendance.
(5) For subsection (4), the minimum number of members is 3.
(6) For subsections (3) and (4), attendance is taken to include attending in person, by phone or by video conference.
Note: this is consistent with the requirements of the incorporated meaning of multidisciplinary case conference team in subsection (2).
Attendance options for the eligible allied health practitioner
(7) For the purposes of an item mentioned in subsection (1), attendance by the eligible allied health practitioner may:
(a) be provided in person, by phone or by video conference; and
(b) differ from the means of attendance provided by other members of the multidisciplinary case conference team.
15 Limitations on case conference items for chronic disease management
(1) This Section applies to items 10955, 10957 and 10959 in Schedule 2.
Eligible patients
(2) An item mentioned in subsection (1) only applies to a service if the patient who the service is provided to:
(a) has at least one medical condition that:
(i) has been (or is likely to be) present for at least six months; or
(ii) is terminal; and
(b) is not an admitted patient of a hospital.
Frequency limitations
(3) An item mentioned in subsection (1) does not apply to a service if the service has been performed in the last 3 months, unless in exceptional circumstances.
(3A) For subsection (3), exceptional circumstances means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service.
Additional requirements on the multidisciplinary case conference team
(4) An item mentioned in subsection (1) only applies to a service if the patient requires ongoing care from a multidisciplinary case conference team which includes at least one medical practitioner (including a general practitioner, but not a specialist or consultant physician).
Eligible allied health practitioners
(5) For the purposes of the items mentioned in subsection (1), eligible allied health practitioner means:
(a) an eligible Aboriginal health worker;
(b) an eligible Aboriginal and Torres Strait Islander health practitioner;
(c) an eligible diabetes educator;
(d) an eligible audiologist;
(e) an eligible dietitian;
(f) an eligible mental health worker;
(g) an eligible occupational therapist;
(h) an eligible exercise physiologist;
(i) an eligible physiotherapist;
(j) an eligible podiatrist;
(k) an eligible chiropractor;
(l) an eligible osteopath;
(m) an eligible psychologist; or
(n) an eligible speech pathologist.
15A Limitations on mental health case conferencing services
(1) This Section applies to items 80176, 80177 and 80178 in Schedule 2.
Eligible patients
(2) An item mentioned in subsection (1) only applies to a service for a patient, if the patient:
(a) either:
(i) is referred for a service to which an item in Subgroup 2 of Group A20; Subgroup 9 of Group A7; Subgroup 3 or 10 of Group A40; Group M6 or M7; or Subgroup 1, 2, 3, 4, 6, 7, 8 or 9 of Group M18 applies; or
(ii) has an eating disorder treatment and management plan; and
(b) is not an admitted patient of a hospital.
Frequency limitations
(3) An item mentioned in subsection (1) does not apply to a service if the service has been performed in the last 3 months, unless in exceptional circumstances.
(3A) For subsection (3), exceptional circumstances means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service.
Additional requirements on the multidisciplinary case conference team
(4) An item mentioned in subsection (1) only applies to a service if the patient requires ongoing care from a multidisciplinary case conference team which includes at least one medical practitioner (including a general practitioner, but not a specialist or consultant physician).
Eligible allied health practitioners
(5) For the purposes of the items mentioned in subsection (1), eligible allied health practitioner means an allied health professional who meets the qualification requirements outlined in Schedule 1 in relation to the provision of a:
(a) psychological therapy health service;
(b) focussed psychological strategies health service; or
(c) dietetics health service.
16 Limitations on case conference items for complex neurodevelopmental disorders
(1) This Section applies to items 82001, 82002 and 82003 in Schedule 2.
Eligible patients
(2) An item mentioned in subsection (1) only applies to a service if the patient:
(a) is a child under 13 years of age; and
(b) has been diagnosed with, or is suspected of having:
(i) a complex neurodevelopmental disorder; or
(ii) an eligible disability; and
(c) is not an admitted patient of a hospital.
Additional requirements on the multidisciplinary case conference team
(3) An item mentioned in subsection (1) only applies to a service if the patient requires ongoing care from a multidisciplinary case conference team which includes:
(a) if the patient has been diagnosed with, or is suspected of having:
(i) a complex neurodevelopmental disorder, a consultant physician in the practice of the consultant physician’s specialty of paediatrics or psychiatry; or
(ii) an eligible disability, a specialist or consultant physician practising in their specialty, or a general practitioner.
Eligible allied health practitioners
(4) For the purposes of the items mentioned in subsection (1), eligible allied health practitioner means:
(a) an eligible Aboriginal health worker;
(b) an eligible Aboriginal and Torres Strait Islander health practitioner;
(c) an eligible psychologist;
(d) an eligible speech pathologist;
(e) an eligible occupational therapist;
(f) an eligible audiologist;
(g) an eligible optometrist;
(h) an eligible mental health nurse;
(i) an eligible mental health worker;
(j) an eligible orthoptist; or
(k) an eligible physiotherapist.
17 Indexation
(1) At the start of 1 November 2023 (the indexation day), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:
Note: The indexed fees could in 2023 be viewed on the Department of Health and Aged Care’s MBS Online website (http://www.health.gov.au).
(2) The amounts covered by this subsection are the fee for each item in Schedule 2 of this Determination.
(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).
