Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Determination 2020
I, DAVID WEISS, delegate of the Minister for Health, make the following determination.
Dated 12 March 2020
David Weiss
First Assistant Secretary
Medical Benefits Division
Health Financing Group
Department of Health
This instrument is the Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Determination 2020.
(1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.
Commencement information | ||
Column 1 | Column 2 | Column 3 |
Provisions | Commencement | Date/Details |
1. The whole of this instrument | 13 March 2020 |
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Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.
(2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.
Unless earlier revoked this instrument ceases on 30 September 2020.
4. Authority
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.
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 choses to receive a benefit from a private health insurer
NOTE: hospital treatment and hospital-substitute treatment have the same meaning as defined in the Health Insurance Act 1973
bulk‑billed: a service in the Determination is bulk‑billed if:
(a) a medicare benefit is payable to a person in relation to the service; and
(b) under an agreement entered into under section 20A of the Act:
(i) the person assigns to the practitioner by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and
(ii) the practitioner accepts the assignment in full payment of the practitioner’s fee for the service provided.
health professional is at risk of COVID-19 virus means a person that:
(a) has been diagnosed with COVID-19 virus but who is not a patient of a hospital; or
(b) has been required to isolate themselves in quarantine in accordance with home isolation guidance issued by Australian Health Protection Principal Committee; or
patient at risk of COVID-19 virus means a person that:
(a) has been diagnosed with COVID-19 virus but who is not a patient of a hospital; or
(b) has been required to isolate themselves in quarantine in accordance with home isolation guidance issued by Australian Health Protection Principal Committee; or
(c) considered more susceptible to the COVID-19 virus being:
(i) at least 70 years old, or
(ii) at least 50 years old or over if of Aboriginal or Torres Strait Islander descent; or
(iii) pregnant; or
(iv) a parent of a child under 12 months; or
(v) a person under treatment for chronic health conditions or who are immune compromised
phone attendance means a professional attendance by telephone where the health practitioner:
(a) has the capacity to provide the full service through this means safely and in accordance with professional standards; and
(b) is satisfied that it is clinically appropriate to provide the service to the patient; and
(c) maintains an audio link with the patient
relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this instrument.
Note: The following terms are defined in subsection 3(1) of the Act:
telehealth attendance means a professional attendance by video conference where the health practitioner:
(a) has the capacity to provide the full service through this means safely and in accordance with professional standards; and
(b) is satisfied that it is clinically appropriate to provide the service to the patient; and
(c) maintains a visual and audio link with the patient; and
(d) is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.
(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.
6. Treatment of relevant services
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
Schedule 1 – Relevant Services
Division 1.1 – Services and fees – COVID-19 medical practitioner attendances
1.1.1 – Application of COVID-19 medical practitioner telehealth services
(1) For items in 91802 and 91805, “eligible area” has the meaning given by section 4 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.
(2) For items in Division 1.1, “medical practitioner” has the meaning given by section 4 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.
(3) Clause 2.22.7 of the general medical services table shall have effect as if items 91806 and 91807 were also specified in that clause.
(4) Clause 1.9.4 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 shall have effect as if items 91808 and 91809 were also specified in that clause.
(5) For items in Subgroups 1 and 2, the rendering practitioner must not perform a service in subgroup 2 if the practitioner and the patient have the capacity to undertake an attendance by telehealth.
(6) For items in Subgroup 1 and 2, the rendering practitioner must have had at least one face to face attendance with the patient in the preceding 12 months if the patient is considered to be more susceptible to the COVID-19.
Group A40 – COVID-19 general practice telehealth services |
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Item | Description | Fee ($) |
Subgroup 1 – COVID-19 general practice telehealth services | ||
91800
| Telehealth attendance by a general practitioner lasting less than 20 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the general practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 44.90 |
91801 | Telehealth attendance by a general practitioner lasting at least 20 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the general practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 87.00 |
91802 | Telehealth attendance by a general practitioner lasting at least 40 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the general practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 128.05 |
91803 | Telehealth attendance by a medical practitioner of more than 5 minutes in duration but not more than 25 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 24.70 |
91804 | Telehealth attendance by a medical practitioner of more than 25 minutes in duration but not more than 45 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 44.70 |
91805 | Telehealth attendance by a medical practitioner of at least 45 minutes in duration if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 71.75 |
91806 | Telehealth attendance by a medical practitioner, in an eligible area, of more than 5 minutes in duration but not more than 25 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 35.90 |
91807 | Telehealth attendance by a medical practitioner, in an eligible area, of more than 25 minutes in duration but not more than 45 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 69.55 |
91808 | Telehealth attendance by a medical practitioner, in an eligible area, of at least 45 minutes in duration if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a patient history; (ii) arranging any necessary investigation (iii) conducting or supervising such clinical examinations as may be practical; (iv) implementing a management plan; (v) providing appropriate preventative health care where the service is bulk-billed | 102.45 |
Subgroup 2 – COVID-19 general practice phone services | ||
91809 | Phone attendance by a general practitioner lasting less than 20 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the general practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 44.90 |
91810 | Phone attendance by a general practitioner lasting at least 20 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the general practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 87.00 |
91811 | Phone attendance by a general practitioner lasting at least 40 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the general practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 128.05 |
91812 | Phone attendance by a medical practitioner of more than 5 minutes in duration but not more than 25 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 24.70 |
91813 | Phone attendance by a medical practitioner of at least 25 minutes in duration but not more than 45 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 44.70 |
91814 | Phone attendance by a medical practitioner of at least 45 minutes in duration if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 71.75 |
91815 | Phone attendance by a medical practitioner, in an eligible area, of more than 5 minutes in duration but not more than 25 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 35.90 |
91816 | Phone attendance by a medical practitioner, in an eligible area, of more than 25 minutes in duration but not more than 45 minutes if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 69.55 |
91817 | Phone attendance by a medical practitioner, in an eligible area, of more than 45 minutes in duration if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the medical practitioner is a health professional at risk of COVID-19 virus; and (b) the attendance includes any of the following that are clinically relevant: (i) taking a short patient history; (ii) limited examination and management; where the service is bulk-billed | 102.45 |
Subgroup 3 – COVID-19 Focussed Psychological Strategies telehealth services | ||
91818 | Telehealth attendance for a patient at risk for COVID-19 virus by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and (b) the service lasts at least 30 minutes, but less than 40 minutes; where the service is bulk-billed | 110.85 |
91819 | Telehealth attendance for a patient at risk for COVID-19 virus by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and (b) the service lasts at least 40 minutes; where the service is bulk-billed | 158.60 |
91820 | Telehealth attendance for a patient at risk for COVID-19 virus by a medical practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and (b) the service lasts at least 30 minutes, but less than 40 minutes; where the service is bulk-billed | 88.70 |
91821 | Telehealth attendance for a patient at risk for COVID-19 virus by a medical practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if: (a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and (b) the service lasts at least 40 minutes; where the service is bulk-billed | 126.90 |
Division 1.2 – Services and fees – COVID-19 allied health telehealth services
1.2.1 – Application of COVID-19 allied health attendances
(1) For items in Division 1.2, “eligible clinical psychologist”, “eligible psychologist”, “eligible occupational therapist” and “eligible social worker” have the meanings given by section 4 of the Health Insurance (Allied Health Services) Determination 2014.
(2) For items 91166 and 91167, sections 7 and 9 of the Health Insurance (Allied Health Services) Determination 2014 shall have effect as if the items were also specified in those clauses.
Group M18 – COVID-19 allied health telehealth services |
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Item | Description | Fee ($) | |||||||||
Subgroup 1 – COVID-19 psychological therapies telehealth services | |||||||||||
91166
| Psychological therapy health service provided by telehealth attendance by an eligible clinical psychologist if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the eligible clinical psychologist is a health professional at risk of COVID-19 virus; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 30 minutes but less than 50 minutes duration; where the service is bulk-billed | 101.35 | |||||||||
91167 | Psychological therapy health service provided by telehealth attendance by an eligible clinical psychologist if: (a) the attendance is where: (i) the person is a patient at risk of COVID-19 virus; or (ii) the eligible clinical psychologist is a health professional at risk of COVID-19 virus; and (b) the person is referred by: (i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or (iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and (c) the service is provided to the person individually; and (d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and (e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and (f) the service is at least 50 minutes duration; where the service is bulk-billed | 148.80 | |||||||||
Subgroup 2 – COVID-19 psychologist focussed psychological strategies telehealth services | |||||||||||
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Subgroup 3 – COVID-19 occupational therapist focussed psychological strategies telehealth services | |||||||||||
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Subgroup 4 – COVID-19 social worker focussed psychological strategies telehealth services | |||||||||||
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Subgroup 5 – COVID-19 nurse practitioner telehealth services | |||||||||||
91178 | Focussed psychological strategies health service provided by telehealth attendance by a participating nurse practitioner lasting less than 20 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care; where the service is bulk-billed. | 21.30 | |||||||||
91179 | Focussed psychological strategies health service provided by telehealth attendance by a participating nurse practitioner lasting at least 20 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care; where the service is bulk-billed. | 40.40 | |||||||||
91180 | Focussed psychological strategies health service provided by telehealth attendance by a participating nurse practitioner lasting at least 40 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care; where the service is bulk-billed. | 59.50 | |||||||||