Commonwealth Coat of Arms of Australia

Health Insurance (General Medical Services Table) Regulations (No. 2) 2020

made under the

Health Insurance Act 1973

Compilation No. 1

Compilation date: 1 August 2020

Includes amendments up to: F2020L00882

Registered: 21 August 2020

About this compilation

This compilation

This is a compilation of the Health Insurance (General Medical Services Table) Regulations (No. 2) 2020 that shows the text of the law as amended and in force on 1 August 2020 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Selfrepealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

 

 

 

Contents

1 Name

2 Commencement

3 Authority

4 General medical services table

5 Schedule 2

Schedule 1—General medical services table

Part 1—Preliminary

Division 1.1—Interpretation

1.1.1 Dictionary

1.1.2 Meaning of eligible nonvocationally recognised medical practitioner

1.1.3 General practitioners

1.1.4 Meaning of multidisciplinary case conference

1.1.5 Meaning of multidisciplinary case conference team

1.1.6 Meaning of single course of treatment

1.1.7 Meaning of symbol (H)

1.1.8 References in this Schedule to items include items determined under section 3C of the Act

Division 1.2—General application provisions

1.2.1 Application

1.2.2 Restrictions on certain items—attendances by specialists and consultant physicians without referrals

1.2.3 Restrictions on certain items—attendances by specialist radiologists in conjunction with certain diagnostic imaging services

1.2.4 Restrictions on certain items—attendances by specialists and consultant physicians on same day as they perform certain surgical operations

1.2.5 Professional attendance services—matters included

1.2.6 Personal attendance by medical practitioners generally—application and matters included

1.2.7 Personal attendance by medical practitioners—application and matters included

1.2.8 Restriction on items—services provided with nonmedicare services

1.2.9 Restrictions on items—services rendered in certain circumstances or for certain purposes

1.2.10 Restriction on items—services provided with harvesting, storage, in vitro processing or injection of nonhaematopoietic stem cells

1.2.11 Services that may be provided by persons other than medical practitioners

1.2.12 Restriction on items—services involving video conferences between patients and medical practitioners separated by at least 15 km

Part 2—Attendances

Division 2.1—Preliminary

2.1.1 Meaning of amount under clause 2.1.1

Division 2.2—Group A1: General practitioner attendances to which no other item applies

2.2.1 Items in Group A1

Division 2.3—Group A2: Other nonreferred attendances to which no other item applies

2.3.1 Items in Group A2

Division 2.4—Group A3: Specialist attendances to which no other item applies

2.4.1 Items in Group A3

Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies

2.5.1 Items in Group A4

Division 2.6—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability

2.6.1 Meaning of eligible disability

2.6.2 Meaning of risk assessment

2.6.3 Items in Group A29

Division 2.7—Group A28: Geriatric medicine

2.7.1 Items in Group A28

Division 2.8—Group A5: Prolonged attendances to which no other item applies

2.8.1 Restrictions on items in Group A5

2.8.2 Items in Group A5

Division 2.9—Group A6: Group therapy

2.9.1 Items in Group A6

Division 2.10—Group A7: Acupuncture and nonspecialist practitioner items

2.10.1 Meaning of qualified medical acupuncturist

2.10.2 Items in Group A7

Division 2.11—Group A8: Consultant psychiatrist attendances to which no other item applies

2.11.1 Restriction on timing of services in items 291, 293 and 359

2.11.2 Restriction on items 342, 344 and 346

2.11.3 Restriction on items 353 to 361—location of patient

2.11.4 Meaning of risk assessment

2.11.5 Items in Group A8

Division 2.12—Group A12: Consultant occupational physician attendances to which no other item applies

2.12.1 Restrictions on items in Group A12—attendances by consultant occupational physicians

2.12.2 Items in Group A12

Division 2.13—Group A13: Public health physician attendances to which no other item applies

2.13.1 Restrictions on items in Group A13—attendances by public health physicians

2.13.2 Items in Group A13

Division 2.14—Group A11: Urgent attendances after—hours

2.14.1 Meaning of patient’s medical condition requires urgent assessment

2.14.2 Restrictions on items in Group A11

2.14.3 Meaning of afterhours rural area

2.14.4 Restrictions on items in Group A11—practitioners

2.14.5 Items in Group A11

Division 2.15—Group A14: Health assessments

2.15.1 Restrictions on items in Group A14

2.15.2 Types of health assessments

2.15.3 Application of item 715

2.15.4 Type 2 Diabetes Risk Evaluation

2.15.5 45 year old Health Assessment

2.15.6 Older Person’s Health Assessment

2.15.7 Comprehensive Medical Assessment for care recipient in a residential aged care facility

2.15.8 Health assessment for a person with an intellectual disability

2.15.9 Health assessment for a refugee or other humanitarian entrant

2.15.10 Australian Defence Force Postdischarge GP Health Assessment

2.15.11 Aboriginal and Torres Strait Islander child health assessment

2.15.12 Aboriginal and Torres Strait Islander adult health assessment

2.15.13 Aboriginal and Torres Strait Islander Older Person’s Health Assessment

2.15.14 Restrictions on health assessments for Group A14

2.15.15 Items in Group A14

Division 2.16—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Subdivision A—General

2.16.1 Restrictions on items 729 to 866—services by certain medical practitioners

Subdivision B—Subgroup 1 of Group A15

2.16.2 Meaning of associated general practitioner

2.16.3 Meaning of contribute to a multidisciplinary care plan

2.16.4 Meaning of coordinating the development of team care arrangements

2.16.5 Meaning of coordinating a review of team care arrangements

2.16.6 Meaning of multidisciplinary care plan

2.16.7 Meaning of preparing a GP management plan

2.16.8 Meaning of reviewing a GP management plan

2.16.9 Restrictions on items 721, 723, 729, 731 and 732—services for certain patients

2.16.10 Restrictions on items 721, 723 and 732

2.16.11 Restrictions on other items—services provided on same day as services in items 721, 723 and 732

2.16.12 Conditions relating to timing of services in items 721, 723, 729, 731 and 732 if exceptional circumstances do not exist

2.16.13 Items in Subgroup 1 of Group A15

Subdivision C—Subgroup 2 of Group A15

2.16.14 Meaning of multidisciplinary discharge case conference

2.16.15 Meaning of organise and coordinate

2.16.16 Meaning of participate

2.16.17 Meaning of coordinating

2.16.18 Meaning of case conference team

2.16.19 Restrictions on item 880—certain patients

2.16.20 Items in Subgroup 2 of Group A15

Division 2.17—Group A17: Domiciliary and residential medication management reviews

2.17.1 Meaning of living in a community setting

2.17.2 Meaning of residential medication management review

2.17.3 Restrictions on items 900 and 903

2.17.4 Items in Group A17

Division 2.18—Group A30: Medical practitioner video conferencing consultation

2.18.1 Restrictions on items in Subgroups 1 and 2 of Group A30—services provided in association with certain other services

2.18.2 Location of attendance in items 2125, 2138, 2179 and 2220

2.18.3 Meaning of amount under clause 2.18.3

2.18.4 Restrictions on items in Subgroups 5 and 6 of Group A30 (video conferencing consultation attendances for patients in rural and remote areas)

2.18.5 Items in Group A30

Division 2.19—Groups A18 and A19 (Attendances associated with Practice Incentive Program payments)

2.19.1 Restrictions on items in Subgroup 2 of Groups A18 and A19—timing

2.19.2 Restrictions on items in Subgroup 3 of Groups A18 and A19—timing

2.19.3 Items in Group A18

2.19.4 Items in Group A19

Division 2.20—Group A20: Mental health care

2.20.1 Definitions

2.20.2 Meaning of amount under clause 2.20.2

2.20.3 Meaning of preparation of a GP mental health treatment plan

2.20.4 Meaning of review of a GP mental health treatment plan

2.20.5 Meaning of associated general practitioner

2.20.6 Restrictions on items in Subgroup 1 of Group A20 (GP mental health treatment plans)

2.20.7 Restrictions on items in Subgroup 2 of Group A20 (focussed psychological strategies)

2.20.8 Items in Group A20

Division 2.21—Group A24: Palliative and pain medicine

2.21.1 Meaning of organise and coordinate

2.21.2 Meaning of participate

2.21.3 Restrictions on items in Subgroups 2 and 4 of Group A24—timing

2.21.4 Items in Group A24

Division 2.22—Group A27: Pregnancy support counselling

2.22.1 Restrictions on item 4001

2.22.2 Items in Group A27

Division 2.23—Group A21: Professional attendances at recognised emergency departments of private hospitals

2.23.1 Items in Group A21

Division 2.24—Group A22: General practitioner afterhours attendances to which no other item applies

2.24.1 Restrictions on items in Group A22—timing

2.24.2 Items in Group A22

Division 2.25—Group A23: Other nonreferred afterhours attendances to which no other item applies

2.25.1 Restrictions on items in Group A23—timing

2.25.2 Items in Group A23

Division 2.26—Group A26: Neurosurgery attendances to which no other item applies

2.26.1 Items in Group A26

Division 2.27—Group A31: Addiction medicine

2.27.1 Meaning of organise and coordinate

2.27.2 Meaning of participate

2.27.3 Restrictions on item 6028

2.27.4 Items in Group A31

Division 2.28—Group A32: Sexual health medicine

2.28.1 Meaning of organise and coordinate

2.28.2 Meaning of participate

2.28.3 Items in Group A32

Division 2.29—Group A9: Contact lenses

2.29.1 Restrictions on item 10809

2.29.2 Items in Group A9

Division 2.30—Group A35: Nonreferred attendance at a residential aged care facility

2.30.1 Fee in relation to the first patient during each attendance at a residential aged care facility

2.30.2 Items in Group A35

Part 3—Miscellaneous services

Division 3.1—Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

3.1.1 Definitions for item 10997

3.1.2 Restrictions on item 10988

3.1.3 Restrictions on item 10989

3.1.4 Items in Group M12

Division 3.2—Group M1: Management of bulkbilled services

3.2.1 Definitions

3.2.2 Restrictions on items 10990, 10991 and 10992

3.2.3 Items in Group M1

Part 4—Diagnostic procedures and investigations

Division 4.1—Group D1: Miscellaneous diagnostic procedures and investigations

4.1.1 Meaning of report

4.1.2 Meaning of qualified adult sleep medicine practitioner, qualified paediatric sleep medicine practitioner and qualified sleep medicine practitioner

4.1.3 Restriction on item 11801—service provided in association with other services

4.1.4 Restrictions on items 12306 to 12322

4.1.5 Items in Group D1

Division 4.2—Group D2: Nuclear medicine (nonimaging)

4.2.1 Restriction on items in Group D2—services connected with services in item 12250

4.2.2 Items in Group D2

Part 5—Therapeutic procedures

Division 5.1—Preliminary

5.1.1 Restriction on items in this Part—services connected with provision of pain pump for postsurgical pain management

Division 5.2—Group T1: Miscellaneous therapeutic procedures

5.2.1 Meaning of comprehensive hyperbaric medicine facility

5.2.2 Meaning of embryology laboratory services

5.2.3 Meaning of treatment cycle

5.2.4 Items provided as part of treatment cycle relating to assisted reproductive services not to apply

5.2.5 Restriction on item 13104—timing

5.2.6 Restriction on items relating to assisted reproductive services—certain pregnancyrelated circumstances

5.2.7 Restrictions on items 14227 to 14242—patients

5.2.8 Restrictions on item 14245—practitioner and timing

5.2.9 Restriction on item 13899—other services performed on the same day

5.2.10 Items in Group T1

Division 5.3—Group T2: Radiation oncology

5.3.1 Meaning of amount under clause 5.3.1

5.3.2 Restrictions on items 15215 to 15272—services provided to implement intensitymodulated radiation therapy dosimetry plans

5.3.3 Restrictions on items 15556, 15559 and 15562

5.3.4 Items in Group T2

Division 5.4—Group T3: Therapeutic nuclear medicine

5.4.1 Items in Group T3

Division 5.5—Group T4: Obstetrics

5.5.1 Definitions for item 16400

5.5.2 Meaning of practice midwife in items 16400 and 16408

5.5.3 Restrictions on item 16400—provider and timing

5.5.4 Items in Group T4

Division 5.6—Group T6: Examination by anaesthetist

5.6.1 Items in Group T6

Division 5.7—Group T7: Regional or field nerve blocks

5.7.1 Meaning of amount under clause 5.7.1

5.7.2 Items in Group T7

Division 5.8—Group T11: Botulinum toxin

5.8.1 Group T11 services do not include supply of botulinum toxin

5.8.2 Restrictions on items in Group T11

5.8.3 Items in Group T11

Division 5.9—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)

5.9.1 Meaning of amount under clause 5.9.1

5.9.2 Meaning of amount under clause 5.9.2

5.9.3 Meaning of service time

5.9.4 Restrictions on items in Group T10

5.9.5 Application of Subgroup 21 of Group T10

5.9.6 Meaning of anaesthesia, assistance and perfusion in Subgroups 21 to 25 of Group T10

5.9.7 Application of Subgroups 22 and 23 of Group T10

5.9.8 Application of Subgroups 24 and 25 of Group T10

5.9.9 Items in Group T10

Division 5.10—Group T8: Surgical operations

Subdivision A—Subgroup 1 of Group T8

5.10.1 Meaning of amount under clause 5.10.1

5.10.2 Meaning of amount under clause 5.10.2

5.10.3 Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures

5.10.4 Restrictions on items 30299 and 30300—patients

5.10.5 Items 30440, 30451, 30492 and 30495 do not include imaging

5.10.6 Restrictions on items 30688, 30690, 30692 and 30694—patient notes

5.10.7 Application of item 35412

5.10.8 Restrictions on items 31569, 31572, 31575, 31578, 31581, 31587 and 31590—services provided on same occasion

5.10.9 Items in Subgroup 1 of Group T8

Subdivision B—Subgroups 2 and 3 of Group T8

5.10.10 Meaning of foreign body in items 35360 to 35363

5.10.11 Application of items 32084 and 32087

5.10.12 Restrictions on items 32500 to 32517 and 35321—methods of providing services

5.10.13 Restrictions on items 35404, 35406 and 35408

5.10.14 When artificial bowel sphincter is contraindicated for items 32220 and 32221

5.10.15 Meaning of eligible stroke centre

5.10.16 Items in Subgroups 2 and 3 of Group T8

Subdivision C—Subgroups 4, 5 and 6 of Group T8

5.10.17 Restriction on items in Subgroup 6 of Group T8—surgical techniques

5.10.18 Items in Subgroups 4, 5 and 6 of Group T8

Subdivision D—Subgroups 7 to 11 of Group T8

5.10.19 Items in Subgroups 7 to 11 of Group T8

Subdivision E—Subgroups 12 and 13 of Group T8

5.10.20 Meaning of amount under clause 5.10.20

5.10.21 Meaning of NOSE Scale

5.10.22 Meaning of maxilla

5.10.23 Items in Subgroups 12 and 13 of Group T8

Subdivision F—Subgroup 14 of Group T8

5.10.24 Restriction on items 46300 to 46534—hand operations

5.10.25 Items in Subgroup 14 of Group T8

Subdivision G—Subgroups 15, 16 and 17 of Group T8

5.10.26 Restriction on item 50303—timing

5.10.27 Restrictions on items 51011 to 51112 and 51115 to 51171—services provided in conjunction with other services in Group T8

5.10.28 Restrictions on items 51061 to 51066—services provided in conjunction with certain other services

5.10.29 Meaning of motion segment

5.10.30 Items in Subgroups 15, 16 and 17 of Group T8

Division 5.11—Group T9: Assistance at operations

5.11.1 Meaning of amount under clause 5.11.1

5.11.2 Meaning of amount under clause 5.11.2

5.11.3 Meaning of amount under clause 5.11.3

5.11.4 Restrictions on items in Group T9—medical practitioner providing assistance at operations

5.11.5 Items in Group T9

Part 6—Oral and maxillofacial services

Division 6.1—Preliminary

6.1.1 Restriction on items Groups O1 to O11—providers of services

Division 6.2—Group O1: Consultations

6.2.1 Items in Group O1

Division 6.3—Group O2: Assistance at operation

6.3.1 Meaning of amount under clause 6.3.1

6.3.2 Restrictions on items in Group O2—approved dental practitioner providing assistance at operations

6.3.3 Items in Group O2

Division 6.4—Group O3: General surgery

6.4.1 Items in Group O3

Division 6.5—Group O4: Plastic and reconstructive

6.5.1 Meaning of maxilla

6.5.2 Items in Group O4

Division 6.6—Group O5: Preprosthetic

6.6.1 Items in Group O5

Division 6.7—Group O6: Neurosurgical

6.7.1 Items in Group O6

Division 6.8—Group O7: Ear, nose and throat

6.8.1 Items in Group O7

Division 6.9—Group O8: Temporomandibular joint

6.9.1 Items in Group O8

Division 6.10—Group O9: Treatment of fractures

6.10.1 Items in Group O9

Division 6.11—Group O11: Regional or field nerve blocks

6.11.1 Items in Group O11

Part 7—Dictionary

7.1.1 Dictionary

Schedule 2—Repeals

Health Insurance (General Medical Services Table) Regulations (No. 1) 2020

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

1  Name

  This instrument is the Health Insurance (General Medical Services Table) Regulations (No. 2) 2020.

2  Commencement

 (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

1 July 2020.

1 July 2020

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.

3  Authority

  This instrument is made under the Health Insurance Act 1973.

4  General medical services table

  For the purposes of subsection 4(1) of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of medical services.

5  Schedule 2

  Each instrument that is specified in Schedule 2 to this instrument is amended or repealed as set out in the applicable items in that Schedule, and any other item in that Schedule has effect according to its terms.

Schedule 1General medical services table

Note: See section 4.

Part 1Preliminary

Division 1.1Interpretation

1.1.1  Dictionary

  The Dictionary in Part 7 defines certain words and expressions that are used in this Schedule, and includes references to certain words and expressions that are defined elsewhere in this Schedule.

1.1.2  Meaning of eligible nonvocationally recognised medical practitioner

 (1) In this Schedule:

eligible nonvocationally recognised medical practitioner means:

 (a) a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:

 (i) is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and

 (ii) is providing general medical services in accordance with that Program; or

 (b) a medical practitioner who:

 (i) is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and

 (ii) is providing general medical services in accordance with that Program; and

 (iii) is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:

 (A) that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and

 (B) of which the Chief Executive Medicare has written notice; or

 (c) a medical practitioner who:

 (i) is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and

 (ii) is providing general medical services in accordance with that Program; and

 (iii) is not vocationally registered under section 3F of the Act; or

 (d) a medical practitioner who:

 (i) is registered as a medical practitioner under the After Hours Other Medical Practitioners Program; and

 (ii) is providing general medical services in accordance with that Program; and

 (iii) is not vocationally registered under section 3F of the Act.

 (2) In subclause (1):

After Hours Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

MedicarePlus for Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program means a program administered by the Department that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

Rural Other Medical Practitioners’ Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

1.1.3  General practitioners

  For the purposes of paragraph (c) of the definition of general practitioner in subsection 3(1) of the Act, the following medical practitioners are specified:

 (a) a medical practitioner who is undertaking a placement in general practice that is approved by the Royal Australian College of General Practitioners (the RACGP):

 (i) as part of a training program for general practice leading to the award of Fellowship of the RACGP; or

 (ii) as part of another training program recognised by the RACGP as being of an equivalent standard;

 (b) an eligible nonvocationally recognised medical practitioner;

 (c) a medical practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited;

 (d) a medical practitioner who is undertaking a placement in general practice that is approved by the Australian College of Rural and Remote Medicine (the ACRRM):

 (i) as part of a training program for general practice leading to the award of Fellowship of the ACRRM; or

 (ii) as part of another training program recognised by the ACRRM as being of an equivalent standard.

Note: For other medical practitioners who are general practitioners, see the definition of general practitioner in subsection 3(1) of the Act and section 22 of the Health Insurance Regulations 2018.

1.1.4  Meaning of multidisciplinary case conference

  In this Schedule:

multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:

 (a) discussing a patient’s history;

 (b) identifying the patient’s multidisciplinary care needs;

 (c) identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;

 (d) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;

 (e) assessing whether previously identified outcomes (if any) have been achieved.

1.1.5  Meaning of multidisciplinary case conference team

 (1) In this Schedule, a multidisciplinary case conference team for a patient:

 (a) includes a medical practitioner; and

 (b) either:

 (i) for items 735 to 758, 825 to 828, 855 to 858, 6029 to 6042 and 6064 to 6075—includes at least 2 other members; or

 (ii) for an item mentioned in subclause (3)—includes at least 3 other members; and

 (c) may also include a family member of the patient.

 (2) For the members mentioned in paragraph (b):

 (a) each member must provide a different kind of care or service to the patient; and

 (b) each member must not be an unpaid carer of the patient; and

 (c) one member may be another medical practitioner.

Example: Other members may be allied health professionals, home and community service providers and care organisers, including the following:

(a) Aboriginal and Torres Strait Islander health practitioners;

(b) asthma educators;

(c) audiologists;

(d) dental therapists;

(e) dentists;

(f) diabetes educators;

(g) dieticians;

(h) mental health workers;

(i) occupational therapists;

(j) optometrists;

(k) orthoptists;

(l) orthotists or prosthetists;

(m) pharmacists;

(n) physiotherapists;

(o) podiatrists;

(p) psychologists;

(q) registered nurses;

(r) social workers;

(s) speech pathologists;

(t) education providers;

(u) “meals on wheels” providers;

(v) personal care workers;

(w) probation officers.

 (3) For the purposes of subparagraph (1)(b)(ii), the items are items 820, 822, 823, 830, 832, 834, 2946, 2949, 2954, 2978, 2984, 2988, 3032, 3040, 3044, 3069 and 3074.

1.1.6  Meaning of single course of treatment

 (1) Use this clause for items 104 to 131, 133, 384 to 388, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6015, 6018, 6019, 6024, 6025, 6026, 6051, 6052, 6058, 6059, 6060, 6062, 6063, 16401, 16404, 16406, 51700 and 51703.

 (2) A single course of treatment for a patient:

 (a) includes:

 (i) the initial attendance on the patient by a specialist or consultant physician; and

 (ii) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and

 (iii) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or by the specialist or consultant physician; but

 (b) does not include:

 (i) referral of the patient to the specialist or consultant physician; or

 (ii) an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under section 102 of the Health Insurance Regulations 2018 if:

 (A) the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and

 (B) the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.

Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

1.1.7  Meaning of symbol (H)

  An item in this Schedule including the symbol (H) applies only to a service performed or provided in a hospital.

1.1.8  References in this Schedule to items include items determined under section 3C of the Act

  A reference in this Schedule to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service.

Division 1.2General application provisions

1.2.1  Application

  An item in this Schedule does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.

1.2.2  Restrictions on certain items—attendances by specialists and consultant physicians without referrals

 (1) Use this clause for items 99 to 137, 141 to 149, 288 to 389, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6016, 6018 to 6028, 6051 to 6063, 13210, 16399, 16401, 16404, 16407, 16408, 16508, 16509, 16533, 16534, 17609 and 17640 to 17655.

 (2) The item does not apply to an attendance on a patient by a specialist or consultant physician if:

 (a) the attendance forms part of a single course of treatment for the patient; and

 (b) the attendance is after the end of the period of validity (under section 102 of the Health Insurance Regulations 2018) of the referral that was valid for the initial attendance on the patient by the specialist or consultant physician in the single course of treatment; and

 (c) the attendance is not within the period of validity (under section 102 of the Health Insurance Regulations 2018) of a later referral.

Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

1.2.3  Restrictions on certain items—attendances by specialist radiologists in conjunction with certain diagnostic imaging services

 (1) Use this clause for items 52, 53, 54, 57, 104 and 105.

 (2) The item does not apply to an attendance on a patient by a specialist in the specialty of diagnostic radiology if the attendance is in association with a service to which any of the following items of the diagnostic imaging services table applies:

 (a) an item in Subgroup 6 of Group I1;

 (b) an item in any of Subgroups 1 to 7 of Group I3;

 (c) items 58900 and 58903 in Subgroup 8 of Group I3;

 (d) item 59103 in Subgroup 9 of Group I3.

1.2.4  Restrictions on certain items—attendances by specialists and consultant physicians on same day as they perform certain surgical operations

 (1) Use this clause for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6019, 6052 and 16404.

 (2) The item does not apply to a service if:

 (a) the service is an attendance on a patient by a specialist or a consultant physician on the same day as the day on which an operation is performed on the patient by the specialist or consultant physician; and

 (b) the operation is a service to which an item in Group T8 applies; and

 (c) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $309.35 or more.

1.2.5  Professional attendance services—matters included

 (1) Use this clause for items 3 to 338, 348 to 389, 410 to 417, 585 to 600, 900, 903, 2497 to 2840, 3003, 3005 to 3028, 5000 to 5267, 6004, 6007 to 6016, 6018 to 6026, 6051 to 6063, 13210, 13899, 16399, 16401, 16404, 16406, 16407, 16508, 16509, 16533, 16534, 17609 to 17690 and 90020 to 90096.

 (2) A professional attendance includes the provision, for a patient, of any of the following services:

 (a) evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the Act;

 (b) formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;

 (c) giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;

 (d) if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;

 (e) providing appropriate preventive health care;

 (f) recording the clinical details of the service or services provided to the patient.

 (3) However, a professional attendance does not include the supply of a vaccine to a patient if:

 (a) the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 65, 5000 to 5267 and 90020 to 90096; and

 (b) the cost of the vaccine is not subsidised by the Commonwealth or a State.

1.2.6  Personal attendance by medical practitioners generally—application and matters included

 (1) Use this clause for items 3 to 149, 173 to 338, 348 to 417, 585 to 600, 2100 to 2478, 2497 to 2840, 3003, 3005 to 3028, 4001 to 6016, 6018 to 6024, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11724, 11921 to 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13210, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14224, 14255 to 14288, 15600, 16003 to 16512, 16515 to 51318 and 90020 to 90096.

 (2) The item applies to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.

 (3) A personal attendance by the medical practitioner on the patient includes any of the following:

 (a) a telepsychiatry consultation to which any of items 353 to 361 applies;

 (b) the planning, management and supervision of the patient on home dialysis to which item 13104 applies;

 (c) participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478, 2799, 2820, 3003, 3015, 6004, 6016, 6025, 6026, 6059, 6060, 13210, 16399 and 17609.

1.2.7  Personal attendance by medical practitioners—application and matters included

 (1) Use this clause for items 3 to 723, 732, 900 to 6016, 6018 to 6024, 6028, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11724, 11728, 11820, 11823, 11921, 12000, 12003, 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13210, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14224, 14255 to 14288, 15600, 16003 to 16512, 16515 to 51318 and 90020 to 90096.

 (2) The item applies to a service provided during a personal attendance by:

 (a) a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or

 (b) a medical practitioner who:

 (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.

 (3) Subclause (2) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

 (4) A personal attendance by the medical practitioner on the patient includes any of the following:

 (a) a telepsychiatry consultation to which any of items 353 to 361 applies;

 (b) the planning, management and supervision of the patient on home dialysis to which item 13104 applies;

 (c) participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478, 2799, 2820, 3003, 3015, 6004, 6016, 6025, 6026, 6059, 6060, 13210, 16399 and 17609.

1.2.8  Restriction on items—services provided with nonmedicare services

  Items 3 to 10816 and 90020 to 90096 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 nonmedicare service.

1.2.9  Restrictions on items—services rendered in certain circumstances or for certain purposes

  An item in this Schedule does not apply to a service described in the item if the service is rendered in any of the following circumstances:

 (a) the service is rendered in relation to the provision of chelation therapy, in the form of the intravenous administration of ethylenediamine tetraacetic acid or any of its salts, otherwise than for the treatment of heavymetal poisoning;

 (b) the service is rendered in association with the injection of human chorionic gonadotrophin in the management of obesity;

 (c) the service is rendered in relation to the use of hyperbaric oxygen therapy in the treatment of multiple sclerosis;

 (d) the service is rendered for the purpose of, or in relation to, the removal of tattoos;

 (e) the service is rendered for the purposes of, or in relation to, the removal from a cadaver of kidneys for transplantation;

 (f) the service is rendered to a patient of a hospital for the purposes of, or in relation to:

 (i) the transplantation of a thoracic or abdominal organ, other than a kidney, or of part of an organ of that kind; or

 (ii) the transplantation of a kidney in conjunction with the transplantation of a thoracic or other abdominal organ, or of a part of an organ of that kind;

 (g) the service is rendered for the purpose of administering microwave (UHF radiowave) cancer therapy, including the intravenous injection of drugs used immediately before or during the therapy;

 (h) the service is rendered to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.

1.2.10  Restriction on items—services provided with harvesting, storage, in vitro processing or injection of nonhaematopoietic stem cells

  An item in this Schedule does not apply to a service described in the item if the service is provided to a patient at the same time as, or in connection with, the harvesting, storage, in vitro processing or injection of nonhaematopoietic stem cells.

1.2.11  Services that may be provided by persons other than medical practitioners

 (1) Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11505, 11506, 11507, 11508, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11713, 11715, 11718, 11721, 11725, 11726, 11727, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12017, 12021, 12022, 12024, 12200, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250 to 12272, 12500 to 12527, 13015, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.

 (2) The item applies whether the medical service is given by:

 (a) a medical practitioner; or

 (b) a person, other than a medical practitioner, who:

 (i) is employed by a medical practitioner; or

 (ii) in accordance with accepted medical practice, acts under the supervision of a medical practitioner.

1.2.12  Restriction on items—services involving video conferences between patients and medical practitioners separated by at least 15 km

  If it is a condition of a service, in an item, involving a video conference between a patient and a medical practitioner that the patient and practitioner be at least 15 km by road from one another, the item does not apply if the patient or the practitioner travels to ensure that the condition is met.

Note: This clause has effect whether the condition is set out in the item or not.

Part 2Attendances

Division 2.1Preliminary

2.1.1  Meaning of amount under clause 2.1.1

  In an item of this Schedule mentioned in column 1 of table 2.1.1:

amount under clause 2.1.1 means the sum of:

 (a) the fee mentioned in column 2 for the item; and

 (b) either:

 (i) if a practitioner attends not more than 6 patients in a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

 (ii) if a practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 4 for the item.

 

Table 2.1.1—Amount under clause 2.1.1

Item

Column 1

Items of this Schedule

Column 2

Fee

Column 3

Amount if not more than 6 patients (to be divided by the number of patients) ($)

Column 4

Amount if more than 6 patients ($)

1

4

The fee for item 3

27.15

2.15

2

24

The fee for item 23

27.15

2.15

3

37

The fee for item 36

27.15

2.15

4

47

The fee for item 44

27.15

2.15

5

58

$8.50

15.50

0.70

6

59, 2610, 2631, 2673

$16.00

17.50

0.70

7

60, 2613, 2633, 2675

$35.50

15.50

0.70

8

65, 2616, 2635, 2677

$57.50

15.50

0.70

9

195

The fee for item 193

26.75

2.10

10

414

The fee for item 410

26.65

2.10

11

415

The fee for item 411

26.65

2.10

12

416

The fee for item 412

26.65

2.10

13

417

The fee for item 413

26.65

2.10

14

2503

The fee for item 2501

26.75

2.10

15

2506

The fee for item 2504

26.75

2.10

16

2509

The fee for item 2507

26.75

2.10

17

2518

The fee for item 2517

26.75

2.10

18

2522

The fee for item 2521

26.75

2.10

19

2526

The fee for item 2525

26.75

2.10

20

2547

The fee for item 2546

26.75

2.10

21

2553

The fee for item 2552

26.75

2.10

22

2559

The fee for item 2558

26.75

2.10

23

5003

The fee for item 5000

26.75

2.10

24

5010

The fee for item 5000

48.15

3.40

25

5023

The fee for item 5020

26.75

2.10

26

5028

The fee for item 5020

48.15

3.40

27

5043

The fee for item 5040

26.75

2.10

28

5049

The fee for item 5040

48.15

3.40

29

5063

The fee for item 5060

26.75

2.10

30

5067

The fee for item 5060

48.15

3.40

31

5220

$18.50

15.50

0.70

32

5223

$26.00

17.50

0.70

33

5227

$45.50

15.50

0.70

34

5228

$67.50

15.50

0.70

35

5260

$18.50

27.95

1.25

36

5263

$26.00

31.55

1.25

37

5265

$45.50

27.95

1.25

38

5267

$67.50

27.95

1.25

 

Division 2.2Group A1: General practitioner attendances to which no other item applies

2.2.1  Items in Group A1

  This clause sets out items in Group A1.

 

Group A1—General practitioner attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

3

Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

17.75

4

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in this Schedule applies) that requires a short patient history and, if necessary, limited examination and management—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

23

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

38.75

24

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in this Schedule applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

36

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

75.05

37

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in this Schedule applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

44

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

110.50

47

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in this Schedule applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

 

Division 2.3Group A2: Other nonreferred attendances to which no other item applies

2.3.1  Items in Group A2

  This clause sets out items in Group A2.

 

Group A2—Other nonreferred attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

52

Professional attendance at consulting rooms lasting not more than 5 minutes (other than a service to which any other item applies) by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

11.00

53

Professional attendance at consulting rooms lasting more than 5 minutes, but not more than 25 minutes (other than a service to which any other item applies) by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

21.00

54

Professional attendance at consulting rooms lasting more than 25 minutes, but not more than 45 minutes (other than a service to which any other item applies) by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

38.00

57

Professional attendance at consulting rooms lasting more than 45 minutes (other than a service to which any other item applies) by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

61.00

58

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in this Schedule applies), lasting not more than 5 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

Amount under clause 2.1.1

59

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in this Schedule applies) lasting more than 5 minutes, but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

Amount under clause 2.1.1

60

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in this Schedule applies) lasting more than 25 minutes, but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

Amount under clause 2.1.1

65

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in this Schedule applies) lasting more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner who is not a general practitioner; or

(b) a Group A1 disqualified general practitioner

Amount under clause 2.1.1

 

Division 2.4Group A3: Specialist attendances to which no other item applies

2.4.1  Items in Group A3

  This clause sets out items in Group A3.

 

Group A3—Specialist attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

99

Professional attendance on a patient by a specialist practising in the specialist’s specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 104 lasting more than 10 minutes; or

(ii) provided with item 105; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 104 or 105

104

Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist’s specialty after referral of the patient to the specialist—initial attendance in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

89.55

105

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

45.00

106

Professional attendance by a specialist in the practice of the specialist’s specialty of ophthalmology and following referral of the patient to the specialist—an initial attendance at which the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses, if that attendance is at consulting rooms or hospital (other than a service to which any of items 104, 109 and 10801 to 10816 applies)

74.30

107

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist—an initial attendance, if that attendance is at a place other than consulting rooms or hospital

131.40

108

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital

83.20

109

Professional attendance by a specialist in the practice of the specialist’s specialty of ophthalmology following referral of the patient to the specialist—an initial attendance at which a comprehensive eye examination, including pupil dilation, is performed on:

(a) a patient aged 9 years or younger; or

(b) a patient aged 14 years or younger with developmental delay;

(other than a service to which any of items 104, 106 and 10801 to 10816 applies)

201.85

111

Professional attendance at consulting rooms or in hospital by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist by a referring practitioner—an attendance after the initial attendance in a single course of treatment, if:

(a) during the attendance, the specialist determines the need to perform an operation on the patient that had not otherwise been scheduled; and

(b) the specialist subsequently performs the operation on the patient, on the same day; and

(c) the operation is a service to which an item in Group T8 applies; and

(d) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $309.35 or more

For any particular patient, once only on the same day

45.00

113

Initial professional attendance lasting 10 minutes or less on a patient by a specialist in the practice of the specialist’s speciality if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

67.20

115

Professional attendance at consulting rooms or in hospital on a day by a medical practitioner (the attending practitioner) who is a specialist or consultant physician in the practice of the attending practitioner’s specialty after referral of the patient to the attending practitioner by a referring practitioner—an attendance after the initial attendance in a single course of treatment, if:

(a) the attending practitioner performs a scheduled operation on the patient on the same day; and

(b) the operation is a service to which an item in Group T8 applies; and

(c) the amount specified in the item in Group T8 as the fee for a service to which that item applies is 309.35 or more; and

(d) the attendance is unrelated to the scheduled operation; and

(e) it is considered a clinical risk to defer the attendance to a later day

For any particular patient, once only on the same day

45.00

Division 2.5Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies

2.5.1  Items in Group A4

  This clause sets out items in Group A4.

 

Group A4—Consultant physician (other than psychiatry) attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

110

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—initial attendance in a single course of treatment

157.95

112

Professional attendance on a patient by a consultant physician practising in the consultant physician’s specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 110 lasting more than 10 minutes; or

(ii) provided with item 116, 119, 132 or 133; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 110, 116, 119, 132 or 133

114

Initial professional attendance lasting 10 minutes or less on a patient by a consultant physician practising in the consultant physician’s specialty if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

118.50

116

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—an attendance (other than a service to which item 119 applies) after the initial attendance in a single course of treatment

79.05

117

Professional attendance at consulting rooms or in hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—an attendance after the initial attendance in a single course of treatment, if:

(a) the attendance is not a minor attendance; and

(b) during the attendance, the consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled; and

(c) the consultant physician subsequently performs the operation on the patient, on the same day; and

(d) the operation is a service to which an item in Group T8 applies; and

(e) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $309.35 or more

For any particular patient, once only on the same day

79.05

119

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—minor attendance

45.00

120

Professional attendance at consulting rooms or in hospital by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—minor attendance, if:

(a) during the attendance, the consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled; and

(b) the consultant physician subsequently performs the operation on the patient, on the same day; and

(c) the operation is a service to which an item in Group T8 applies; and

(d) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $309.35 or more

For any particular patient, once only on the same day

45.00

122

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—initial attendance in a single course of treatment

191.65

128

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—an attendance (other than a service to which item 131 applies) after the initial attendance in a single course of treatment

115.90

131

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—minor attendance

83.50

132

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) lasting at least 45 minutes for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to the consultant physician by a referring practitioner, if:

(a) an assessment is undertaken that covers:

(i) a comprehensive history, including psychosocial history and medication review; and

(ii) comprehensive multi or detailed single organ system assessment; and

(iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

(i) an opinion on diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

276.25

133

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) lasting at least 20 minutes after the initial attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

(a) a review is undertaken that covers:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

(i) a revised opinion on the diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) item 132 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same consultant physician who claimed item 132 or a locum tenens; and

(f) this item has not applied more than twice in any 12 month period

138.30

 

Division 2.6Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability

2.6.1  Meaning of eligible disability

  In this Schedule:

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) PraderWilli syndrome;

 (h) Williams syndrome;

 (i) Angelman syndrome;

 (j) Kabuki syndrome;

 (k) SmithMagenis 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.

2.6.2  Meaning of risk assessment

  In items 135, 137 and 139:

risk assessment means an assessment of:

 (a) the risk to the patient of a contributing comorbidity; and

 (b) environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.

2.6.3  Items in Group A29

  This clause sets out items in Group A29.

 

Group A29—Early intervention services for children with autism, pervasive developmental disorder or disability

Column 1

Item

Column 2

Description

Column 3

Fee ($)

135

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty of paediatrics, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or another pervasive developmental disorder, if the consultant paediatrician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medical recommendations;

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 137, 139 or 289)

276.25

137

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a specialist or consultant physician (not including a general practitioner) following referral of the patient to the specialist or consultant physician by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the specialist or consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 139 or 289)

276.25

139

Professional attendance lasting at least 45 minutes at consulting rooms only, by a general practitioner (not including a specialist or consultant physician) for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the general practitioner does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 289)

138.70

 

Division 2.7Group A28: Geriatric medicine

2.7.1  Items in Group A28

  This clause sets out items in Group A28.

 

Group A28—Geriatric medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

141

Professional attendance lasting more than 60 minutes at consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

(i) the medical, physical, psychological and social aspects of the patient’s health are evaluated in detail using appropriately validated assessment tools if indicated (the assessment); and

(ii) the patient’s various health problems and care needs are identified and prioritised (the formulation); and

(iii) a detailed management plan is prepared (the management plan) setting out:

(A) the prioritised list of health problems and care needs; and

(B) short and longer term management goals; and

(C) recommended actions or intervention strategies to be undertaken by the patient’s general practitioner or another relevant health care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient and the patient’s family and carers; and

(iv) the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

(v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(e) an attendance to which this item or item 145 applies has not been provided to the patient by the same practitioner in the preceding 12 months

473.80

143

Professional attendance lasting more than 30 minutes at consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under item 141 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

(i) the patient’s health status is reassessed; and

(ii) a management plan prepared under item 141 or 145 is reviewed and revised; and

(iii) the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring practitioner; and

(c) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies was not provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e) an attendance to which this item or item 147 applies has not been provided to the patient in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

296.20

145

Professional attendance lasting more than 60 minutes at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

(i) the medical, physical, psychological and social aspects of the patient’s health are evaluated in detail utilising appropriately validated assessment tools if indicated (the assessment); and

(ii) the patient’s various health problems and care needs are identified and prioritised (the formulation); and

(iii) a detailed management plan is prepared (the management plan) setting out:

(A) the prioritised list of health problems and care needs; and

(B) short and longer term management goals; and

(C) recommended actions or intervention strategies, to be undertaken by the patient’s general practitioner or another relevant health care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient, the patient’s family and any carers; and

(iv) the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

(v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(e) an attendance to which this item or item 141 applies has not been provided to the patient by the same practitioner in the preceding 12 months

574.50

147

Professional attendance lasting more than 30 minutes at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under items 141 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

(i) the patient’s health status is reassessed; and

(ii) a management plan that was prepared under item 141 or 145 is reviewed and revised; and

(iii) the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring practitioner; and

(c) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e) an attendance to which this item or 143 applies has not been provided by the same practitioner in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

359.10

149

Professional attendance on a patient by a consultant physician or specialist practising in the consultant physician’s or specialist’s specialty of geriatric medicine if:

(a) the attendance is by video conference; and

(b) item 141 or 143 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician or specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 141 or 143

 

Division 2.8Group A5: Prolonged attendances to which no other item applies

2.8.1  Restrictions on items in Group A5

 (1) Items 160 to 164 apply only to a service provided in the course of a personal attendance by one or more general practitioners, specialists or consultant physicians on a single patient on a single occasion.

 (2) If the personal attendance is provided by one or more general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee.

 (3) However, if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance.

2.8.2  Items in Group A5

  This clause sets out items in Group A5.

 

Group A5—Prolonged attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

160

Professional attendance for a period of not less than 1 hour but less than 2 hours (other than a service to which another item applies) on a patient in imminent danger of death

228.45

161

Professional attendance for a period of not less than 2 hours but less than 3 hours (other than a service to which another item applies) on a patient in imminent danger of death

380.70

162

Professional attendance for a period of not less than 3 hours but less than 4 hours (other than a service to which another item applies) on a patient in imminent danger of death

532.75

163

Professional attendance for a period of not less than 4 hours but less than 5 hours (other than a service to which another item applies) on a patient in imminent danger of death

685.35

164

Professional attendance for a period of 5 hours or more (other than a service to which another item applies) on a patient in imminent danger of death

761.45

 

Division 2.9Group A6: Group therapy

2.9.1  Items in Group A6

  This clause sets out items in Group A6.

 

Group A6—Group therapy

Column 1

Item

Column 2

Description

Column 3

Fee ($)

170

Professional attendance for the purpose of group therapy lasting at least 1 hour given under the direct continuous supervision of a general practitioner, specialist or consultant physician (other than a consultant physician in the practice of the consultant physician’s specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each group of 2 patients

121.25

171

Professional attendance for the purpose of group therapy lasting at least 1 hour given under the direct continuous supervision of a general practitioner, specialist or consultant physician (other than a consultant physician in the practice of the consultant physician’s specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each group of 3 patients

127.75

172

Professional attendance for the purpose of group therapy lasting at least 1 hour given under the direct continuous supervision of a general practitioner, specialist or consultant physician (other than a consultant physician in the practice of the consultant physician’s specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each group of 4 or more patients

155.40

 

Division 2.10Group A7: Acupuncture and nonspecialist practitioner items

2.10.1  Meaning of qualified medical acupuncturist

  A general practitioner is a qualified medical acupuncturist, for an item, if the Chief Executive Medicare has received a written notice from the Royal Australian College of General Practitioners stating that the general practitioner meets the skills requirements for providing the service described in the item.

2.10.2  Items in Group A7

  This clause sets out items in Group A7.

 

Group A7—Acupuncture and nonspecialist practitioner items

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Acupuncture

173

Professional attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture was performed

21.65

193

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

38.20

195

Professional attendance by a general practitioner who is a qualified medical acupuncturist, on one or more patients at a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Amount under clause 2.1.1

197

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

73.95

199

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

108.85

 

Division 2.11Group A8: Consultant psychiatrist attendances to which no other item applies

2.11.1  Restriction on timing of services in items 291, 293 and 359

  Items 291, 293 and 359 may only apply once in a 12 month period.

2.11.2  Restriction on items 342, 344 and 346

  Items 342, 344 and 346 apply only to a service provided in the course of a personal attendance by a single medical practitioner.

2.11.3  Restriction on items 353 to 361—location of patient

  Items 353 to 361 apply only to a consultation that is provided to a patient in a regional, rural or remote area.

2.11.4  Meaning of risk assessment

  In item 289:

risk assessment means an assessment of:

 (a) the risk to the patient of a contributing comorbidity; and

 (b) environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.

2.11.5  Items in Group A8

  This clause sets out items in Group A8.

 

Group A8—Consultant psychiatrist attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

288

Professional attendance on a patient by a consultant physician practising in the consultant physician’s specialty of psychiatry if:

(a) the attendance is by video conference; and

(b) item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352

289

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with autism or another pervasive developmental disorder, if the consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to the referring practitioner;

(d) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 139)

276.25

291

Professional attendance lasting more than 45 minutes at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

(a) the attendance follows referral of the patient to the consultant for an assessment or management by a medical practitioner in general practice (including a general practitioner, but not a specialist or consultant physician) or a participating nurse practitioner; and

(b) during the attendance, the consultant:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(c) the consultant decides that it is clinically appropriate for the patient to be managed by the referring practitioner without ongoing treatment by the consultant; and

(d) within 2 weeks after the attendance, the consultant:

(i) prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that:

(A) covers the next 12 months; and

(B) is appropriate to the patient’s diagnosis; and

(C) comprehensively evaluates the patient’s biological, psychological and social issues; and

(D) addresses the patient’s diagnostic psychiatric issues; and

(E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

(iii) gives the referring practitioner a copy of the diagnosis and the management plan; and

(iv) if clinically appropriate, explains the diagnosis and management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

473.80

293

Professional attendance lasting more than 30 minutes, but not more than 45 minutes, at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

(a) the patient is being managed by a medical practitioner or a participating nurse practitioner in accordance with a management plan prepared by the consultant in accordance with item 291; and

(b) the attendance follows referral of the patient to the consultant for review of the management plan by the medical practitioner or a participating nurse practitioner managing the patient; and

(c) during the attendance, the consultant:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

(d) within 2 weeks after the attendance, the consultant:

(i) prepares a written diagnosis of the patient; and

(ii) revises the management plan; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees; and

(e) in the preceding 12 months, a service to which item 291 applies has been provided; and

(f) in the preceding 12 months, a service to which this item or item 293 applies has not been provided

296.20

296

Professional attendance lasting more than 45 minutes by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance at consulting rooms if the patient:

(a) is a new patient for this consultant physician; or

(b) has not received a professional attendance from this consultant physician in the preceding 24 months;

other than attendance on a patient in relation to whom this item, item 297 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months

272.50

297

Professional attendance lasting more than 45 minutes by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance at hospital if the patient:

(a) is a new patient for this consultant physician; or

(b) has not received a professional attendance from this consultant physician in the preceding 24 months;

other than attendance on a patient in relation to whom this item, item 296 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months (H)

272.50

299

Professional attendance lasting more than 45 minutes by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance at a place other than consulting rooms or a hospital if the patient:

(a) is a new patient for this consultant physician; or

(b) has not received a professional attendance from this consultant physician in the preceding 24 months;

other than attendance on a patient in relation to whom this item, item 296 or 297, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months

325.80

300

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting not more than 15 minutes at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

45.35

302

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 15 minutes, but not more than 30 minutes, at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

90.50

304

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 30 minutes, but not more than 45 minutes, at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

139.30

306

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes, but not more than 75 minutes, at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

192.25

308

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 75 minutes at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

223.10

310

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting not more than 15 minutes at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

22.60

312

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 15 minutes, but not more than 30 minutes, at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

45.35

314

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 30 minutes, but not more than 45 minutes, at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

69.80

316

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes, but not more than 75 minutes, at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

96.25

318

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 75 minutes at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

111.60

319

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes at consulting rooms, if the patient has:

(a) been diagnosed as suffering severe personality disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, substancerelated disorder, somatoform disorder or a pervasive development disorder; and

(b) for persons 18 years and over—been rated with a level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning Scale;

if that attendance and another attendance to which any of items 296, 300 to 319, 353 to 358 and 361 to 370 applies have not exceeded 160 attendances in a calendar year for the patient

192.25

320

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting not more than 15 minutes at hospital

45.35

322

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 15 minutes, but not more than 30 minutes, at hospital

90.50

324

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 30 minutes, but not more than 45 minutes, at hospital

139.30

326

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes, but not more than 75 minutes, at hospital

192.25

328

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 75 minutes at hospital

223.10

330

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting not more than 15 minutes if that attendance is at a place other than consulting rooms or hospital

83.30

332

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 15 minutes, but not more than 30 minutes, if that attendance is at a place other than consulting rooms or hospital

130.45

334

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 30 minutes, but not more than 45 minutes, if that attendance is at a place other than consulting rooms or hospital

190.10

336

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes, but not more than 75 minutes, if that attendance is at a place other than consulting rooms or hospital

230.00

338

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 75 minutes if that attendance is at a place other than consulting rooms or hospital

261.20

342

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) lasting at least 1 hour given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry, involving a group of 2 to 9 unrelated patients or a family group of more than 3 patients, each of whom is referred to the consultant physician by a referring practitioner—each patient

51.60

344

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) lasting at least 1 hour given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry, involving a family group of 3 patients, each of whom is referred to the consultant physician by a referring practitioner—each patient

68.50

346

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) lasting at least 1 hour given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry, involving a family group of 2 patients, each of whom is referred to the consultant physician by a referring practitioner—each patient

101.30

348

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, involving an interview of a person other than the patient lasting at least 20 minutes, but less than 45 minutes, in the course of initial diagnostic evaluation of a patient

132.65

350

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, involving an interview of a person other than the patient lasting not less than 45 minutes, in the course of initial diagnostic evaluation of a patient

183.15

352

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, involving an interview of a person other than the patient lasting at least 20 minutes, in the course of continuing management of a patient—if that attendance and another attendance to which this item applies have not exceeded 4 in a calendar year for the patient

132.65

353

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a telepsychiatry consultation lasting not more than 15 minutes, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

59.90

355

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a telepsychiatry consultation lasting more than 15 minutes, but not more than 30 minutes, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

119.75

356

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a telepsychiatry consultation lasting more than 30 minutes, but not more than 45 minutes, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

175.60

357

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a telepsychiatry consultation lasting more than 45 minutes, but not more than 75 minutes, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

242.25

358

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a telepsychiatry consultation lasting more than 75 minutes, if:

(a) that attendance and another attendance to which any of items 353 to 358 and 361 applies have not exceeded 12 attendances in a calendar year for the patient; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

295.20

359

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry—a telepsychiatry consultation lasting more than 30 minutes, but not more than 45 minutes, if:

(a) the patient is being managed by a medical practitioner or a participating nurse practitioner in accordance with a management plan prepared by the consultant physician in accordance with item 291; and

(b) the attendance follows referral of the patient to the consultant physician for review of the management plan by the referring practitioner managing the patient; and

(c) during the attendance, the consultant physician:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

(d) within 2 weeks after the attendance, the consultant physician:

(i) prepares a written diagnosis of the patient; and

(ii) revises the management plan; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees; and

(e) the patient is located in a regional, rural or remote area; and

(f) in the preceding 12 months, a service to which item 291 applies has been performed; and

(g) in the preceding 12 months, a service to which this item or item 293 applies has not been performed

340.60

361

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a telepsychiatry consultation lasting more than 45 minutes, if the patient:

(a) either:

(i) is a new patient for this consultant physician; or

(ii) has not received a professional attendance from this consultant physician in the preceding 24 months; and

(b) is located in a regional, rural or remote area;

other than attendance on a patient in relation to whom this item, item 296, 297 or 299, or any of items 300 to 346 and 353 to 370, has applied in the preceding 24 month period

313.30

364

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a facetoface consultation lasting not more than 15 minutes, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

45.35

366

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a facetoface consultation lasting more than 15 minutes, but not more than 30 minutes, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

90.50

367

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a facetoface consultation lasting more than 30 minutes, but not more than 45 minutes, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

139.30

369

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a facetoface consultation lasting more than 45 minutes, but not more than 75 minutes, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

192.40

370

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—a facetoface consultation lasting more than 75 minutes, if:

(a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 and 361 applies before that attendance; and

(b) that attendance and another attendance to which any of items 296 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

223.10

Division 2.12Group A12: Consultant occupational physician attendances to which no other item applies

2.12.1  Restrictions on items in Group A12—attendances by consultant occupational physicians

  Items 384 to 389 apply to an attendance by a consultant occupational physician only if the attendance relates to one or more of the following matters:

 (a) evaluating and assessing a patient’s rehabilitation requirements when, in the consultant’s opinion, the patient has an accepted medical condition that:

 (i) may be affected by the patient’s working environment; or

 (ii) affects the patient’s capacity to be employed;

 (b) managing an accepted medical condition that, in the consultant’s opinion, may affect a patient’s capacity for continued employment, or return to employment, following a noncompensable accident, injury or illhealth;

 (c) evaluating and forming an opinion about, including management as the case requires, a patient’s medical condition when causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.

2.12.2  Items in Group A12

  This clause sets out items in Group A12.

 

Group A12—Consultant occupational physician attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

384

Initial professional attendance lasting 10 minutes or less on a patient by a consultant occupational physician practising in the consultant occupational physician’s specialty of occupational medicine if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

67.20

385

Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of the consultant occupational physician’s specialty of occupational medicine following referral of the patient to the consultant occupational physician by a referring practitioner—initial attendance in a single course of treatment

89.55

386

Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of the consultant occupational physician’s specialty of occupational medicine following referral of the patient to the consultant occupational physician by a referring practitioner—an attendance after the initial attendance in a single course of treatment

45.00

387

Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of the consultant occupational physician’s specialty of occupational medicine following referral of the patient to the consultant occupational physician by a referring practitioner—initial attendance in a single course of treatment

131.40

388

Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of the consultant occupational physician’s specialty of occupational medicine following referral of the patient to the consultant occupational physician by a referring practitioner—an attendance after the initial attendance in a single course of treatment

83.20

389

Professional attendance on a patient by a consultant occupational physician practising in the consultant occupational physician’s specialty of occupational medicine if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 385 lasting more than 10 minutes; or

(ii) provided with item 386; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician; or

50% of the fee for item 385 or 386

 

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

 

Division 2.13Group A13: Public health physician attendances to which no other item applies

2.13.1  Restrictions on items in Group A13—attendances by public health physicians

  Items 410 to 417 apply to an attendance on a patient by a public health physician only if the attendance relates to one or more of the following matters:

 (a) management of a patient’s vaccination requirements for immunisation programs;

 (b) prevention or management of sexually transmitted disease;

 (c) prevention or management of disease caused by scientifically accepted environmental hazards or toxins;

 (d) prevention or management of infection arising from an outbreak of an infectious disease;

 (e) prevention or management of an exotic disease.

2.13.2  Items in Group A13

  This clause sets out items in Group A13.

 

Group A13—Public health physician attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

410

Professional attendance at consulting rooms by a public health physician in the practice of the public health physician’s specialty of public health medicine—attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

20.45

411

Professional attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

44.75

412

Professional attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

86.55

413

Professional attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

127.45

414

Professional attendance at other than consulting rooms by a public health physician in the practice of the public health physician’s specialty of public health medicine—attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

Amount under clause 2.1.1

415

Professional attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine at other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

Amount under clause 2.1.1

416

Professional attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine at other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

Amount under clause 2.1.1

417

Professional attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine at other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

Amount under clause 2.1.1

 

Division 2.14Group A11: Urgent attendances after—hours

2.14.1  Meaning of patient’s medical condition requires urgent assessment

 (1) A patient’s medical condition requires urgent assessment if:

 (a) medical opinion is to the effect that the patient’s medical condition requires assessment within the unbroken afterhours period in which the attendance mentioned in the item was requested; and

 (b) assessment could not be delayed until the start of the next inhours period.

 (2) For the purposes of subclause (1), medical opinion is to a particular effect if:

 (a) the attending practitioner is of that opinion; and

 (b) in the circumstances that existed and on the information available when the opinion was formed, that opinion would be acceptable to the general body of medical practitioners.

2.14.2  Restrictions on items in Group A11

 (1) Items 585 to 600 do not apply to a service provided by a medical practitioner if:

 (a) the service is provided at consulting rooms; and

 (b) the practitioner:

 (i) routinely provides services to patients in afterhours periods at consulting rooms; or

 (ii) provides the service (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in afterhours periods at consulting rooms.

 (2) Items 585 to 600 do not apply to a professional attendance requested by:

 (a) the attending medical practitioner; or

 (b) an employee of the attending medical practitioner; or

 (c) a person contracted by, or an employee or member of, the general practice of which the attending medical practitioner is a contractor, employee or member; or

 (d) a call centre; or

 (e) a reception service.

 (3) Also, item 585, 588, 591, 599 or 600 applies to a service only if the practitioner keeps a record of the assessment of the patient.

2.14.3  Meaning of afterhours rural area

  In this Schedule:

afterhours rural area means an area that is a Modified Monash 3 area, Modified Monash 4 area, Modified Monash 5 area, Modified Monash 6 area or Modified Monash 7 area.

2.14.4  Restrictions on items in Group A11—practitioners

 (1) Item 585 does not apply to a service described in the item that is provided by an eligible nonvocationally recognised medical practitioner registered under the After Hours Other Medical Practitioners Program (within the meaning of subclause 1.1.2(2)) who provides the service through a medical deputising service.

 (2) Each of items 588 and 591 apply to a service described in the item only if the service is rendered by:

 (a) a medical practitioner other than a general practitioner; or

 (b) an eligible nonvocationally recognised medical practitioner registered under the After Hours Other Medical Practitioners Program (within the meaning of subclause 1.1.2(2)) who provides the service through a medical deputising service.

2.14.5  Items in Group A11

  This clause sets out items in Group A11.

 

Group A11—Urgent attendances after hours

Column 1

Item

Column 2

Description

Column 3

Fee ($)

585

Professional attendance by a general practitioner on one patient on one occasion in an afterhours period outside unsociable hours if:

(a) the attendance is requested by or on behalf of the patient in the same unbroken afterhours period; and

(b) the patient’s medical condition requires urgent assessment; and

(c) if the attendance is at consulting rooms—it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

133.90

588

Professional attendance by a medical practitioner on one patient on one occasion in an afterhours period outside unsociable hours if:

(a) the attendance is requested by or on behalf of the patient in the same unbroken afterhours period; and

(b) the patient’s medical condition requires urgent assessment; and

(c) the attendance is in an afterhours rural area; and

(d) if the attendance is at consulting rooms—it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

133.90

591

Professional attendance by a medical practitioner on one patient on one occasion in an afterhours period outside unsociable hours if:

(a) the attendance is requested by or on behalf of the patient in the same unbroken afterhours period; and

(b) the patient’s medical condition requires urgent assessment; and

(c) the attendance is not in an afterhours rural area; and

(d) if the attendance is at consulting rooms—it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

92.80

594

Professional attendance by a medical practitioner—each additional patient at an attendance that qualifies for item 585, 588 or 591 in relation to the first patient

43.25

599

Professional attendance by a general practitioner on one patient on one occasion in unsociable hours if:

(a) the attendance is requested by or on behalf of the patient in the same unbroken afterhours period; and

(b) the patient’s medical condition requires urgent assessment; and

(c) if the attendance is at consulting rooms—it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

157.80

600

Professional attendance by a medical practitioner (other than a general practitioner) on one patient on one occasion in unsociable hours if:

(a) the attendance is requested by or on behalf of the patient in the same unbroken afterhours period; and

(b) the patient’s medical condition requires urgent assessment; and

(c) if the attendance is at consulting rooms—it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance

126.10

 

Division 2.15Group A14: Health assessments

2.15.1  Restrictions on items in Group A14

  Items 701 to 715 apply only to a service provided in the course of a personal attendance by a single general practitioner on a single patient.

2.15.2  Types of health assessments

 (1) The following health assessments may be performed under item 701, 703, 705 or 707:

 (a) a Type 2 Diabetes Risk Evaluation, in accordance with clause 2.15.4, for a patient who:

 (i) is at least 40 years old and under 50 years old; and

 (ii) has a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool; and

 (iii) is not an inpatient of a hospital;

 (b) a 45 year old Health Assessment, in accordance with clause 2.15.5, for a patient who is:

 (i) at least 45 years old and under 50 years old; and

 (ii) at risk of developing a chronic disease; and

 (iii) not an inpatient of a hospital or a care recipient in a residential aged care facility;

 (c) an Older Person’s Health Assessment, in accordance with clause 2.15.6, for a patient who is:

 (i) at least 75 years old; and

 (ii) not an inpatient of a hospital or a care recipient in a residential aged care facility;

 (d) a Comprehensive Medical Assessment, in accordance with clause 2.15.7, for a patient who is a care recipient in a residential aged care facility;

 (e) a health assessment, in accordance with clause 2.15.8, for a person with an intellectual disability, if the patient is not an inpatient of a hospital or a care recipient in a residential aged care facility;

 (f) a health assessment, in accordance with clause 2.15.9, for a patient who:

 (i) is a refugee or humanitarian entrant, with eligibility for Medicare; and

 (ii) either:

 (A) holds a relevant visa that the person has held for less than 12 months at the time of the assessment; or

 (B) first entered Australia less than 12 months before the assessment is performed; and

 (iii) is not an inpatient of a hospital or a care recipient in a residential aged care facility;

 (g) an Australian Defence Force Postdischarge GP Health Assessment, in accordance with clause 2.15.10, for a patient who:

 (i) is a former member of the Permanent Forces (within the meaning of the Defence Act 1903) or a former member of the Reserves (within the meaning of that Act); and

 (ii) has not already received such an assessment.

 (2) In this clause:

relevant visa means any of the following visas granted under the Migration Act 1958:

 (a) Subclass 070 Bridging (Removal Pending) visa;

 (b) Subclass 200 (Refugee) visa;

 (c) Subclass 201 (Incountry Special Humanitarian) visa;

 (d) Subclass 202 (Global Special Humanitarian) visa;

 (e) Subclass 203 (Emergency Rescue) visa;

 (f) Subclass 204 (Woman at Risk) visa;

 (g) Subclass 695 (Return Pending) visa;

 (h) Subclass 786 (Temporary (Humanitarian Concern)) visa;

 (i) Subclass 866 (Protection) visa.

2.15.3  Application of item 715

 (1) Item 715 applies to the following health assessments:

 (a) an Aboriginal and Torres Strait Islander child health assessment, in accordance with clause 2.15.11, for a patient if the patient is:

 (i) under 15 years old; and

 (ii) not an inpatient of a hospital or a care recipient in a residential aged care facility;

 (b) an Aboriginal and Torres Strait Islander adult health assessment, in accordance with clause 2.15.12, for a patient if the patient is:

 (i) at least 15 years old and under 55 years old; and

 (ii) not an inpatient of a hospital or a care recipient in a residential aged care facility;

 (c) an Aboriginal and Torres Strait Islander Older Person’s Health Assessment, in accordance with clause 2.15.13, for a patient if the patient is:

 (i) at least 55 years old; and

 (ii) not an inpatient of a hospital or a care recipient in a residential aged care facility.

 (2) For the purpose of item 715, a person is of Aboriginal or Torres Strait Islander descent if the person identifies as being of that descent.

2.15.4  Type 2 Diabetes Risk Evaluation

 (1) A Type 2 Diabetes Risk Evaluation must include:

 (a) a review of the risk factors underlying a patient’s high risk score as identified by the Australian Type 2 Diabetes Risk Assessment Tool; and

 (b) initiating interventions, if appropriate, to address risk factors or to exclude diabetes.

 (2) The Type 2 Diabetes Risk Evaluation for a patient must also include:

 (a) assessing the patient’s high risk score as determined by the Australian Type 2 Diabetes Risk Assessment Tool (to be completed by the patient within 3 months before performing the Type 2 Diabetes Risk Evaluation); and

 (b) updating the patient’s history and performing physical examinations and clinical investigations; and

 (c) making an overall assessment of the patient’s risk factors and the results of examinations and investigations; and

 (d) initiating interventions, if appropriate, including referrals and followup services relating to the management of any risk factors identified; and

 (e) giving the patient advice and information, including strategies to achieve lifestyle and behaviour changes if appropriate.

 (3) A Type 2 Diabetes Risk Evaluation must not be provided more than once every 3 years to an eligible person.

 (4) For this clause, risk factors includes:

 (a) lifestyle risk factors (for example smoking, physical inactivity or poor nutrition); and

 (b) biomedical risk factors (for example high blood pressure, impaired glucose metabolism or excess weight); and

 (c) a family history of a chronic disease.

2.15.5  45 year old Health Assessment

 (1) A 45 year old Health Assessment is an assessment for a patient if the patient, in the clinical judgement of the attending general practitioner based on the identification of a specific risk factor, is at risk of developing a chronic disease.

 (2) The 45 year old Health Assessment must include:

 (a) information collection, including taking a patient’s history and performing examinations and investigations, as required; and

 (b) making an overall assessment of the patient; and

 (c) initiating interventions or referrals, as appropriate; and

 (d) giving health advice and information to the patient.

 (3) The general practitioner providing the assessment is responsible for the overall health assessment of the patient.

 (4) A 45 year old Health Assessment must not be given more than once to an eligible person.

 (5) In this clause:

chronic disease means a disease that has been, or is likely to be, present for at least 6 months, including asthma, cancer, cardiovascular illness, diabetes mellitus, a mental health condition, arthritis or a musculoskeletal condition.

specific risk factors includes:

 (a) lifestyle risk factors (for example smoking, physical inactivity, poor nutrition or alcohol misuse); and

 (b) biomedical risk factors (for example high cholesterol, high blood pressure, impaired glucose metabolism or excess weight); and

 (c) a family history of a chronic disease.

2.15.6  Older Person’s Health Assessment

 (1) An Older Person’s Health Assessment is the assessment of:

 (a) a patient’s health and physical, psychological and social function; and

 (b) whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.

 (2) An Older Person’s Health Assessment must include:

 (a) personal attendance by a general practitioner; and

 (b) measurement of the patient’s blood pressure, pulse rate and rhythm; and

 (c) assessment of the patient’s medication; and

 (d) assessment of the patient’s continence; and

 (e) assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and

 (f) assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months; and

 (g) assessment of the patient’s psychological function, including the patient’s cognition and mood; and

 (h) assessment of the patient’s social function, including:

 (i) the availability and adequacy of paid, and unpaid, help; and

 (ii) whether the patient is responsible for caring for another person.

 (3) An Older Person’s Health Assessment must also include:

 (a) keeping a record of the health assessment; and

 (b) offering the patient a written report on the health assessment, with recommendations about matters covered by the health assessment; and

 (c) offering the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

 (4) An Older Person’s Health Assessment must not be provided more than once every 12 months to an eligible person.

2.15.7  Comprehensive Medical Assessment for care recipient in a residential aged care facility

 (1) A Comprehensive Medical Assessment of a care recipient in a residential aged care facility includes an assessment of the resident’s health and physical and psychological function.

 (2) A Comprehensive Medical Assessment must include:

 (a) a personal attendance by a general practitioner; and

 (b) taking a detailed patient history of the resident; and

 (c) conducting a comprehensive medical examination of the resident; and

 (d) developing a list of diagnoses and medical problems based on the medical history and examination; and

 (e) giving a written copy of a summary of the outcomes of the assessment to the residential aged care facility for the resident’s medical records.

 (3) A Comprehensive Medical Assessment must also include:

 (a) making a written summary of the Comprehensive Medical Assessment; and

 (b) giving a copy of the summary to the residential aged care facility; and

 (c) offering the resident a copy of the summary.

 (4) A Comprehensive Medical Assessment may be provided:

 (a) on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided in another residential aged care facility in the last 12 months; and

 (b) at 12 month intervals after that assessment.

 (5) A Comprehensive Medical Assessment may be performed in conjunction with a consultation for another purpose, but must be claimed separately.

2.15.8  Health assessment for a person with an intellectual disability

 (1) A health assessment for a person with an intellectual disability is an assessment of:

 (a) the patient’s physical, psychological and social function; and

 (b) whether any medical intervention and preventive health care is required.

 (2) The health assessment for a person with an intellectual disability must include the following matters to the extent that they are relevant to the patient:

 (a) checking dental health (including dentition);

 (b) conducting an aural examination (including arranging a formal audiometry if an audiometry has not been conducted within the last 5 years);

 (c) assessing ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within the last 5 years);

 (d) assessing nutritional status (including weight and height measurements) and a review of growth and development;

 (e) assessing bowel and bladder function (particularly for incontinence or chronic constipation);

 (f) assessing medications including:

 (i) nonprescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications; and

 (ii) advice to carers on the common sideeffects and interactions; and

 (iii) consideration of the need for a formal medication review;

 (g) checking immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps, rubella and pneumococcal vaccinations);

 (h) checking exercise opportunities (with the aim of moderate exercise for at least 30 minutes each day);

 (i) checking whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and considering formal review if required;

 (j) considering the need for breast examination, mammography, papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;

 (k) checking for dysphagia and gastrooesophageal disease (especially for patients with cerebral palsy) and arranging for investigation or treatment as required;

 (l) assessing risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication and fracture history) and arranging for investigation or treatment as required;

 (m) for a patient diagnosed with epilepsy—reviewing seizure control (including anticonvulsant drugs) and considering referral to a neurologist at appropriate intervals;

 (n) screening for thyroid disease at least every 2 years (or yearly for patients with Down syndrome);

 (o) for a patient without a definitive aetiological diagnosis—considering referral to a genetic clinic every 5 years;

 (p) assessing or reviewing treatment for comorbid mental health issues;

 (q) considering timing of puberty and management of sexual development, sexual activity and reproductive health;

 (r) considering whether there are any signs of physical, psychological or sexual abuse.

 (3) A health assessment for a person with an intellectual disability must also include:

 (a) keeping a record of the health assessment; and

 (b) offering the patient a written report on the health assessment; and

 (c) offering the patient’s carer (if any, and if the general practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report; and

 (d) offering relevant disability professionals (if the general practitioner considers it appropriate and the patient or, if appropriate, the patient’s carer, agrees) a copy of the report or extracts of the report.

 (4) A health assessment for a person with an intellectual disability must not be provided more than once every 12 months to an eligible person.

2.15.9  Health assessment for a refugee or other humanitarian entrant

 (1) A health assessment for a refugee or other humanitarian entrant is the assessment of:

 (a) the patient’s health and physical, psychological and social function; and

 (b) whether preventive health care and education should be offered to the patient to improve their health and physical, psychological or social function.

 (2) A health assessment for a refugee or other humanitarian entrant must include:

 (a) a personal attendance by a general practitioner; and

 (b) taking the patient’s history; and

 (c) examining the patient; and

 (d) performing or arranging any required investigations; and

 (e) assessing the patient, using the information gained in paragraphs (b), (c) and (d); and

 (f) developing a management plan addressing the patient’s health care needs, health problems and relevant conditions; and

 (g) making or arranging any necessary interventions and referrals.

 (3) A health assessment for a refugee or other humanitarian entrant must also include:

 (a) keeping a record of the health assessment; and

 (b) offering to provide the patient with a written report of the health assessment.

 (4) A health assessment for a refugee or other humanitarian entrant must not be provided to a patient more than once.

2.15.10  Australian Defence Force Postdischarge GP Health Assessment

 (1) An Australian Defence Force Postdischarge GP Health Assessment is an assessment of:

 (a) a patient’s physical and psychological health and social function; and

 (b) whether health care, education or other assistance should be offered to the patient to improve the patient’s physical or psychological health or social function.

 (2) The assessment must be performed by the patient’s usual doctor.

 (3) The assessment must not be performed in conjunction with a separate consultation in relation to the patient unless the consultation is clinically necessary.

 (4) The assessment may be performed using the ADF Postdischarge GP Health Assessment Tool, as existing on 1 July 2020.

Note 1: The ADF Postdischarge GP Health Assessment Tool could in 2020 be viewed on the Department of Veterans’ Affairs’ At Ease website (http://atease.dva.gov.au).

Note 2: Other assessment tools mentioned in the Department of Veterans’ Affairs’ Mental Health Advice Book may be relevant. The Mental Health Advice Book could in 2020 be viewed on the Department of Veterans’ Affairs’ At Ease website (http://atease.dva.gov.au).

 (5) The assessment must include taking a history of the patient that includes the following:

 (a) the patient’s service with the Australian Defence Force, including service type, years of service, field of work, number of deployments and reason for discharge;

 (b) the patient’s social history, including relationship status, number of children (if any) and current occupation;

 (c) the patient’s current medical conditions;

 (d) whether the patient suffers from hearing loss or tinnitus;

 (e) the patient’s use of medication, including medication prescribed by another doctor and medication obtained without a prescription;

 (f) the patient’s smoking, if applicable;

 (g) the patient’s alcohol use, if applicable;

 (h) the patient’s substance use, if applicable;

 (i) the patient’s level of physical activity;

 (j) whether the patient has bodily pain;

 (k) whether the patient has difficulty getting to sleep or staying asleep;

 (l) whether the patient has psychological distress;

 (m) whether the patient has posttraumatic stress disorder;

 (n) whether the patient is at risk of harm to self or others;

 (o) whether the patient has anger problems;

 (p) the patient’s sexual health;

 (q) any other health concerns the patient has.

 (6) The assessment must also include the following:

 (a) measuring the patient’s height;

 (b) weighing the patient and ascertaining, or asking the patient, whether the patient’s weight has changed in the last 12 months;

 (c) measuring the patient’s waist circumference;

 (d) taking the patient’s blood pressure;

 (e) using information gained in the course of taking the patient’s history to assess whether any further assessment of the patient’s health is necessary;

 (f) either:

 (i) making the further assessment mentioned in paragraph (e); or

 (ii) referring the patient to another medical practitioner who can make the further assessment;

 (g) documenting a strategy for improving the patient’s health;

 (h) offering to give the patient a written report of the assessment that makes recommendations for treating the patient including preventive health measures.

 (7) The doctor must keep a record of the assessment.

 (8) In this clause:

usual doctor, in relation to a patient, means a general practitioner employed by a medical practice:

 (a) that has provided at least 50% of the primary health care required by the patient in the last 12 months; or

 (b) that the patient anticipates will provide at least 50% of the patient’s primary health care requirements in the next 12 months.

2.15.11  Aboriginal and Torres Strait Islander child health assessment

 (1) An Aboriginal and Torres Strait Islander child health assessment is the assessment of:

 (a) a patient’s health and physical, psychological and social function; and

 (b) whether preventive health care, education and other assistance should be offered to the patient, or the patient’s parent or carer, to improve the patient’s health and physical, psychological or social function.

 (2) An Aboriginal and Torres Strait Islander child health assessment must include:

 (a) a personal attendance by a general practitioner; and

 (b) taking the patient’s history, including the following:

 (i) mother’s pregnancy history;

 (ii) birth and neonatal history;

 (iii) breastfeeding history;

 (iv) weaning, food access and dietary history;

 (v) physical activity engaged in;

 (vi) previous presentations, hospital admissions and medication use;

 (vii) relevant family medical history;

 (viii) immunisation status;

 (ix) vision and hearing (including neonatal hearing screening);

 (x) development (including achievement of ageappropriate milestones);

 (xi) family relationships, social circumstances and whether the person is cared for by another person;

 (xii) exposure to environmental factors (including tobacco smoke);

 (xiii) environmental and living conditions;

 (xiv) educational progress;

 (xv) stressful life events experienced;

 (xvi) mood (including incidence of depression and risk of selfharm);

 (xvii) substance use;

 (xviii) sexual and reproductive health;

 (xix) dental hygiene (including access to dental services); and

 (c) examination of the patient, including the following:

 (i) measurement of the patient’s height and weight to calculate the patient’s body mass index and position on the growth curve;

 (ii) newborn baby check (if not previously completed);

 (iii) vision (including red reflex in a newborn);

 (iv) ear examination (including otoscopy);

 (v) oral examination (including gums and dentition);

 (vi) trachoma check, if indicated;

 (vii) skin examination, if indicated;

 (viii) respiratory examination, if indicated;

 (ix) cardiac auscultation, if indicated;

 (x) development assessment, to determine whether ageappropriate milestones have been achieved, if indicated;

 (xi) assessment of parent and child interaction, if indicated;

 (xii) other examinations as indicated by a previous child health assessment; and

 (d) performing or arranging any required investigation, in particular considering the need for the following tests:

 (i) haemoglobin testing for those at a high risk of anaemia;

 (ii) audiometry, especially for school age children; and

 (e) assessing the patient using the information gained in the child health assessment; and

 (f) making or arranging any necessary interventions and referrals, and documenting a strategy for the good health of the patient; and

 (g) both:

 (i) keeping a record of the health assessment; and

 (ii) offering the patient, or the patient’s parent or carer, a written report on the health assessment, with recommendations on matters covered by the health assessment (including a strategy for the good health of the patient).

2.15.12  Aboriginal and Torres Strait Islander adult health assessment

 (1) An Aboriginal and Torres Strait Islander adult health assessment is the assessment of:

 (a) a patient’s health and physical, psychological and social function; and

 (b) whether preventive health care, education and other assistance should be offered to the patient to improve their health and physical, psychological or social function.

 (2) An Aboriginal and Torres Strait Islander adult health assessment must include:

 (a) personal attendance by a general practitioner; and

 (b) taking the patient’s history, including the following:

 (i) current health problems and risk factors;

 (ii) relevant family medical history;

 (iii) medication use (including medication obtained without prescription or from other doctors);

 (iv) immunisation status, by reference to the appropriate current age and sex immunisation schedule;

 (v) sexual and reproductive health;

 (vi) physical activity, nutrition and alcohol, tobacco or other substance use;

 (vii) hearing loss;

 (viii) mood (including incidence of depression and risk of selfharm);

 (ix) family relationships and whether the patient is a carer, or is cared for by another person;

 (x) vision; and

 (c) examination of the patient, including the following:

 (i) measurement of the patient’s blood pressure, pulse rate and rhythm;

 (ii) measurement of height and weight to calculate the patient’s body mass index and, if indicated, measurement of waist circumference for central obesity;

 (iii) oral examination (including gums and dentition);

 (iv) ear and hearing examination (including otoscopy and, if indicated, a whisper test);

 (v) urinalysis (by dipstick) for proteinuria;

 (vi) eye examination; and

 (d) performing or arranging any required investigation, in particular considering the need for the following tests:

 (i) fasting blood sugar and lipids (by laboratorybased test on venous sample) or, if necessary, random blood glucose levels;

 (ii) papanicolaou smear;

 (iii) examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those 15 to 35 years old);

 (iv) mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral); and

 (e) assessing the patient using the information gained in the health assessment; and

 (f) making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

 (3) An Aboriginal and Torres Strait Islander adult health assessment must also include:

 (a) keeping a record of the health assessment; and

 (b) offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment (including a simple strategy for the good health of the patient).

2.15.13  Aboriginal and Torres Strait Islander Older Person’s Health Assessment

 (1) An Aboriginal and Torres Strait Islander Older Person’s Health Assessment is the assessment of:

 (a) a patient’s health and physical, psychological and social function; and

 (b) whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological or social function.

 (2) An Aboriginal and Torres Strait Islander Older Person’s Health Assessment must include:

 (a) personal attendance by a general practitioner; and

 (b) measurement of the patient’s blood pressure, pulse rate and rhythm; and

 (c) assessment of the patient’s medication; and

 (d) assessment of the patient’s continence; and

 (e) assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and

 (f) assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months; and

 (g) assessment of the patient’s psychological function, including the patient’s cognition and mood; and

 (h) assessment of the patient’s social function, including:

 (i) the availability and adequacy of paid, and unpaid, help; and

 (ii) whether the patient is responsible for caring for another person; and

 (i) an examination of the patient’s eyes.

 (3) An Aboriginal and Torres Strait Islander Older Person’s Health Assessment must also include:

 (a) keeping a record of the health assessment; and

 (b) offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment; and

 (c) offering the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

2.15.14  Restrictions on health assessments for Group A14

 (1) A health assessment mentioned in an item in Group A14 must not include a health screening service.

 (2) A separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.

 (3) A health assessment must be performed by the patient’s usual general practitioner, if reasonably practicable.

 (4) Practice nurses, Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners may assist general practitioners in performing a health assessment, in accordance with accepted medical practice, and under the supervision of the general practitioner.

 (5) For the purposes of subclause (4), assistance may include activities associated with:

 (a) information collection; and

 (b) at the direction of the general practitioner—provision to patients of information on recommended interventions.

 (6) In this clause:

health screening service has the same meaning as in subsection 19(5) of the Act.

2.15.15  Items in Group A14

  This clause sets out items in Group A14.

 

Group A14—Health assessments

Column 1

Item

Column 2

Description

Column 3

Fee ($)

701

Professional attendance by a general practitioner (other than a specialist or consultant physician) to perform a brief health assessment, lasting not more than 30 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing the patient with preventive health care advice and information

61.20

703

Professional attendance by a general practitioner (other than a specialist or consultant physician) to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:

(a) detailed information collection, including taking a patient history; and

(b) an extensive physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing a preventive health care strategy for the patient

142.20

705

Professional attendance by a general practitioner (other than a specialist or consultant physician) to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient’s medical condition and physical function; and

(c) initiating interventions and referrals as indicated; and

(d) providing a basic preventive health care management plan for the patient

196.25

707

Professional attendance by a general practitioner (other than a specialist or consultant physician) to perform a prolonged health assessment, lasting at least 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient’s medical condition, and physical, psychological and social function; and

(c) initiating interventions or referrals as indicated; and

(d) providing a comprehensive preventive health care management plan for the patient

277.20

715

Professional attendance by a general practitioner (other than a specialist or consultant physician) at consulting rooms or in another place other than a hospital or residential aged care facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent—not more than once in a 9 month period

218.90

 

Division 2.16Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Subdivision AGeneral

2.16.1  Restrictions on items 729 to 866—services by certain medical practitioners

 (1) Items 729 to 866 apply only to a service provided by:

 (a) a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or

 (b) a medical practitioner who:

 (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.

 (2) Paragraph (1)(b) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

Subdivision BSubgroup 1 of Group A15

2.16.2  Meaning of associated general practitioner

  In item 732:

associated general practitioner means a general practitioner who, if not engaged in the same general practice as the general practitioner mentioned in the item, performs the service described in the item at the request of the patient (or the patient’s guardian).

2.16.3  Meaning of contribute to a multidisciplinary care plan

  In items 729 and 731:

contribute to a multidisciplinary care plan, for a patient, includes the following:

 (a) preparing part of a multidisciplinary care plan and adding a copy of that part of the plan to the patient’s medical records;

 (b) preparing amendments to part of a multidisciplinary care plan and adding a copy of the amendments to the patient’s medical records;

 (c) giving advice to a person who prepares part of a multidisciplinary care plan and recording in writing, on the patient’s medical records, any advice provided to the person;

 (d) giving advice to a person who reviews part of a multidisciplinary care plan and recording in writing, on the patient’s medical records, any advice provided to the person.

2.16.4  Meaning of coordinating the development of team care arrangements

 (1) In item 723:

coordinating the development of team care arrangements means a process by which a general practitioner:

 (a) in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and one of whom may be another medical practitioner, makes arrangements for the multidisciplinary care of the patient; and

 (b) prepares a document that describes the following:

 (i) treatment and service goals for the patient;

 (ii) treatment and services that collaborating providers will provide to the patient;

 (iii) actions to be taken by the patient;

 (iv) arrangements to review the matters mentioned in subparagraphs (i), (ii) and (iii) by a day mentioned in the document; and

 (c) undertakes all of the following activities:

 (i) explains the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);

 (ii) discusses with the patient the collaborating providers who will contribute to the development of team care arrangements, and provide treatment and services to the patient under those arrangements;

 (iii) records the patient’s agreement to the development of team care arrangements;

 (iv) gives the collaborating provider a copy of those parts of the document that relate to the collaborating provider’s treatment of the patient’s condition;

 (v) offers a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);

 (vi) adds a copy of the document to the patient’s medical records.

 (2) For this clause, a collaborating provider is a person who:

 (a) provides treatment or a service to a patient; and

 (b) is not an unpaid carer of the patient.

2.16.5  Meaning of coordinating a review of team care arrangements

 (1) In item 732:

coordinating a review of team care arrangements means a process by which a general practitioner:

 (a) in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and one of whom may be another medical practitioner, reviews the matters mentioned in:

 (i) paragraph (b) of the definition of coordinating the development of team care arrangements in subclause 2.16.4(1); and

 (ii) paragraph (a) of the definition of preparing a GP management plan in clause 2.16.7;

  as applicable; and

 (b) if different arrangements need to be made—makes amendments to the plan, or to the document mentioned in paragraph (b) of the definition of coordinating the development of team care arrangements in subclause 2.16.4(1), that:

 (i) state the new arrangements; and

 (ii) provide for the review of the amended plan or document by a date stated in the plan or document; and

 (c) explains the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (d) records the patient’s agreement to the review of team care arrangements or the plan; and

 (e) gives the collaborating provider a copy of those parts of the amended document, or the amended plan, that relate to the collaborating provider’s treatment of the patient’s condition; and

 (f) offers a copy of the amended document, or plan, to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (g) adds a copy of the amended document or plan to the patient’s medical records.

 (2) For this clause, a collaborating provider is a person who:

 (a) provides treatment or a service to a patient; and

 (b) is not an unpaid carer of the patient.

2.16.6  Meaning of multidisciplinary care plan

 (1) In items 729 and 731:

multidisciplinary care plan, for a patient, means a written plan that:

 (a) is prepared for the patient by:

 (i) a general practitioner, in consultation with 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and one of whom may be another medical practitioner; or

 (ii) a collaborating provider (other than a general practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and

 (b) describes, at least, treatment and services to be provided to the patient by the collaborating providers.

 (2) For this clause, a collaborating provider is a person, including a medical practitioner, who:

 (a) provides treatment or a service to a patient; and

 (b) is not an unpaid carer of the patient.

2.16.7  Meaning of preparing a GP management plan

  In item 721:

preparing a GP management plan, for a patient, means a process by which a general practitioner:

 (a) prepares a written plan for the patient that describes:

 (i) the patient’s condition and associated health care needs; and

 (ii) management goals with which the patient agrees; and

 (iii) actions to be taken by the patient; and

 (iv) treatment and services the patient is likely to need; and

 (v) arrangements for providing the treatment and services mentioned in subparagraph (a)(iv); and

 (vi) arrangements to review the plan by a day mentioned in the plan; and

 (b) explains to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and

 (c) records the plan; and

 (d) records the patient’s agreement to the preparation of the plan; and

 (e) offers a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (f) adds a copy of the plan to the patient’s medical records.

2.16.8  Meaning of reviewing a GP management plan

  In item 732:

reviewing a GP management plan means a process by which a general practitioner:

 (a) reviews the matters mentioned in paragraph (a) of the definition of preparing a GP management plan in clause 2.16.7; and

 (b) if different arrangements need to be made—makes amendments to the plan that:

 (i) state the new arrangements; and

 (ii) provide for a further review of the amended plan by a date stated in the plan; and

 (c) explains to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review; and

 (d) records the patient’s agreement to the review of the plan; and

 (e) if amendments are made to the plan:

 (i) offers a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (ii) adds a copy of the amended plan to the patient’s medical records.

2.16.9  Restrictions on items 721, 723, 729, 731 and 732—services for certain patients

 (1) An item of this Schedule mentioned in column 1 of table 2.16.9 applies only to a service for a patient who:

 (a) suffers from at least one medical condition that:

 (i) has been (or is likely to be) present for at least 6 months; or

 (ii) is terminal; and

 (b) is described in column 2 of table 2.16.9.

 

Table 2.16.9—Application of items 721, 723, 729, 731 and 732

Item

Column 1

Items of this Schedule

Column 2

Description of patient

1

721 and 732
(if the service is for preparing a GP management plan or reviewing a GP management plan)

The patient:

(a) is a private inpatient of a hospital; or

(b) is not a public inpatient of a hospital or a care recipient in a residential aged care facility

2

723 and 732
(if the service is for the creation or review of team care arrangements)

The patient:

(a) requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and

(b) either:

(i) is a private inpatient of a hospital; or

(ii) is not a public inpatient of a hospital or a care recipient in a residential aged care facility

3

729

The patient:

(a) requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and

(b) is not a care recipient in a residential aged care facility

4

731

The patient:

(a) requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and

(b) is a care recipient in a residential aged care facility

 

 (2) For this clause, a collaborating provider is a person who:

 (a) provides treatment or a service to a patient; and

 (b) is not an unpaid carer of the patient.

2.16.10  Restrictions on items 721, 723 and 732

  Items 721, 723 and 732 apply only to a service provided in the course of personal attendance by a single general practitioner on a single patient.

2.16.11  Restrictions on other items—services provided on same day as services in items 721, 723 and 732

  The following items do not apply to a service described in the item that is provided by a general practitioner, if the service is provided on the same day for the same patient for whom the practitioner provides a service described in item 721, 723 or 732:

 (a) items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60 and 65;

 (b) items 585, 588, 591, 594, 599 and 600;

 (c) items 5000, 5003, 5020, 5023, 5040, 5043, 5060 and 5063;

 (d) items 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228.

2.16.12  Conditions relating to timing of services in items 721, 723, 729, 731 and 732 if exceptional circumstances do not exist

 (1) This clause applies to the performances of services for a patient for whom exceptional circumstances do not exist.

 (2) Items 721, 723, 729, 731 and 732 apply in the circumstances mentioned in table 2.16.12.

 

Table 2.16.12—Conditions relating to timing of services in items 721, 723, 729, 731 and 732

Item

Column 1

Item of

this Schedule

Column 2

Circumstances

1

721

(a) In the 3 months before performance of the service, being a service to which item 729, 731 or 732 (for reviewing a GP management plan) applies but had not been performed for the patient; and

(b) the service is not performed more than once in a 12 month period; and

(c) the service is not performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

2

723

(a) In the 3 months before performance of the service, being a service to which item 732 (for coordinating a review of team care arrangements, a multidisciplinary community care plan or a multidisciplinary discharge care plan) applies but had not been performed for the patient; and

(b) the service is performed not more than once in a 12 month period; and

(c) the service is not performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

3

729

(a) either:

(i) in the 3 months before performance of the service, being a service to which item 731 or 732 applies but had not been performed for the patient; or

(ii) in the 12 months before performance of the service, being a service that has not been performed for the patient:

(A) by the general practitioner who performs the service to which item 729 would, but for this item, apply; and

(B) for which a payment has been made under item 721 or 723; and

(b) the service is performed not more than once in a 3 month period

4

731

(a) In the 3 months before performance of the service, being a service to which item 721, 723, 729 or 732 applies but had not been performed for the patient; and

(b) the service is performed not more than once in a 3 month period

5

732

Each service may be performed:

(a) once in a 3 month period; and

(b) on the same day; but

(c) may not be performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

 

 (3) In this clause:

exceptional circumstances, for a patient, means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

2.16.13  Items in Subgroup 1 of Group A15

  This clause sets out items in Subgroup 1 of Group A15.

 

Group A15—GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—GP management plans, team care arrangements and multidisciplinary care plans

721

Attendance by a general practitioner (not including a specialist or consultant physician), for preparation of a GP management plan for a patient (other than a service associated with a service to which any of items 735 to 758 apply)

148.75

723

Attendance by a general practitioner (not including a specialist or consultant physician), to coordinate the development of team care arrangements for a patient (other than a service associated with a service to which any of items 735 to 758 apply)

117.90

729

Contribution by a general practitioner (not including a specialist or consultant physician), to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 735 to 758 apply)

72.60

731

Contribution by a general practitioner (not including a specialist or consultant physician), to:

(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or

(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider

(other than a service associated with a service to which items 735 to 758 apply)

72.60

732

Attendance by a general practitioner (not including a specialist or consultant physician) to review or coordinate a review of:

(a) a GP management plan prepared by a general practitioner (or an associated general practitioner) to which item 721 applies; or

(b) team care arrangements which have been coordinated by the general practitioner (or an associated general practitioner) to which item 723 applies

74.30

 

Subdivision CSubgroup 2 of Group A15

2.16.14  Meaning of multidisciplinary discharge case conference

  In items 735, 739, 743, 747, 750 and 758:

multidisciplinary discharge case conference means a multidisciplinary case conference carried out for a patient before the patient is discharged from a hospital.

2.16.15  Meaning of organise and coordinate

  In items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866:

organise and coordinate, for a conference mentioned in the item, means undertaking all of the following activities:

 (a) explaining to the patient the nature of the conference;

 (b) asking the patient whether the patient agrees to the conference taking place;

 (c) recording the patient’s agreement to the conference;

 (d) recording the day the conference was held and the times the conference started and ended;

 (e) recording the names of the participants;

 (f) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records;

 (g) offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

 (h) discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

2.16.16  Meaning of participate

  In items 747, 750, 758, 825, 826, 828, 835, 837 and 838:

participate, for a conference mentioned in the item, means participation that:

 (a) does not include organising and coordinating the conference; and

 (b) involves undertaking all of the following activities in relation to the conference:

 (i) explaining to the patient the nature of the conference;

 (ii) asking the patient whether the patient agrees to the practitioner’s participation in the conference;

 (iii) recording the patient’s agreement to the practitioner’s participation in the conference;

 (iv) recording the day the conference was held and the times the conference started and ended;

 (v) recording the names of the participants;

 (vi) recording the matters mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records.

2.16.17  Meaning of coordinating

  In item 880:

coordinating, for a case conference, means undertaking all of the following activities:

 (a) coordinating and facilitating the case conference;

 (b) resolving any disagreement or conflict to enable the members of the case conference team giving care and service to the patient to agree on the outcomes to be achieved;

 (c) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;

 (d) recording the input of each member and the outcome of the case conference.

2.16.18  Meaning of case conference team

  In item 880:

case conference team:

 (a) includes a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of geriatric or rehabilitation medicine; and

 (b) includes at least 2 other allied health professionals, each of whom provides a different kind of care or service to the patient and is not a medical practitioner or unpaid carer of the patient; and

 (c) may include the patient, an unpaid carer of the patient or a medical practitioner.

Example: For the purposes of paragraph (b), persons who may be included in a team are the following:

(a) dieticians;

(b) mental health workers;

(c) occupational therapists;

(d) pharmacists;

(e) physiotherapists;

(f) podiatrists;

(g) psychologists;

(h) social workers;

(i) speech pathologists.

2.16.19  Restrictions on item 880—certain patients

 (1) Item 880 applies if the attendance is on a patient who:

 (a) is an admitted patient of a hospital; and

 (b) is not a care recipient in a residential aged care facility; and

 (c) is being provided with one of the following types of specialist care:

 (i) geriatric evaluation and management;

 (ii) rehabilitation care.

 (2) In this clause:

geriatric evaluation and management means care provided to a patient with a disability or psychosocial problem for the purpose of maximising the patient’s health status or optimising the patient’s living arrangements.

rehabilitation care means care provided to a patient with an impairment or disability for the purpose of improving the patient’s functional status.

2.16.20  Items in Subgroup 2 of Group A15

  This clause sets out items in Subgroup 2 of Group A15.

 

Group A15—GP management plans, team care arrangements and multidisciplinary care plans and case conferences

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 2—Case conferences

735

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which items 721 to 732 apply)

72.90

739

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

124.75

743

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

207.95

747

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which items 721 to 732 apply)

53.55

750

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

91.75

758

Attendance by a general practitioner (not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in:

(a) a community case conference; or

(b) a multidisciplinary case conference carried out for a care recipient in a residential aged care facility; or

(c) a multidisciplinary discharge case conference;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which items 721 to 732 apply)

152.80

820

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

145.60

822

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

218.50

823

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

291.10

825

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, with the multidisciplinary case conference team

104.55

826

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

166.75

828

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes, with the multidisciplinary case conference team

229.00

830

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

145.60

832

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

218.50

834

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines

291.10

835

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

104.55

837

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

166.75

838

Attendance by a consultant physician in the practice of the consultant physician’s specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

229.00

855

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with the multidisciplinary case conference team

145.60

857

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

218.50

858

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 45 minutes, with the multidisciplinary case conference team

291.10

861

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

145.60

864

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

218.50

866

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

291.10

871

Attendance by a general practitioner, specialist or consultant physician, as a member of a case conference team, to lead and coordinate a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 3 other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

84.05

872

Attendance by a general practitioner, specialist or consultant physician, as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 4 medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

39.15

880

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of geriatric or rehabilitation medicine, as a member of a case conference team, to coordinate a case conference of at least 10 minutes but less than 30 minutes—for any particular patient, one attendance only in a 7 day period (other than attendance on the same day as an attendance for which item 832, 834, 835, 837 or 838 was applicable in relation to the patient) (H)

50.95

 

Division 2.17Group A17: Domiciliary and residential medication management reviews

2.17.1  Meaning of living in a community setting

  In item 900:

living in a community setting: a patient is living in a community setting if the patient is not an inpatient of a hospital or a care recipient in a residential aged care facility.

2.17.2  Meaning of residential medication management review

 (1) In item 903:

residential medication management review means a collaborative service provided by a general practitioner and a pharmacist to review the medication management needs of a care recipient in a residential aged care facility.

 (2) A general practitioner’s involvement in a residential medication management review includes all of the following:

 (a) discussing the proposed review with the resident and seeking the resident’s consent to the review;

 (b) collaborating with the reviewing pharmacist about the pharmacist’s involvement in the review;

 (c) providing input from the resident’s most recent comprehensive medical assessment or, if such an assessment has not been undertaken, providing relevant clinical information for the review and for the resident’s records;

 (d) subject to subclause (4), participating in a postreview discussion (either facetoface or by telephone) with the pharmacist to discuss the outcomes of the review including:

 (i) the findings of the review; and

 (ii) medication management strategies; and

 (iii) means to ensure that the strategies are implemented and reviewed, including any issues for implementation and followup;

 (e) developing or revising the resident’s medication management plan after discussion with the reviewing pharmacist, and finalising the plan after discussion with the resident.

 (3) A general practitioner’s involvement in a residential medication management review also includes:

 (a) offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate); and

 (b) providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and

 (c) discussing the plan with nursing staff if necessary.

 (4) A postreview discussion is not required if:

 (a) there are no recommended changes to the resident’s medication management arising out of the review; or

 (b) any changes are minor in nature and do not require immediate discussion; or

 (c) the pharmacist and general practitioner agree that issues arising out of the review should be considered in a case conference.

2.17.3  Restrictions on items 900 and 903

  Items 900 and 903 apply only to a service provided in the course of personal attendance by a single general practitioner on a single patient.

2.17.4  Items in Group A17

  This clause sets out items in Group A17.

 

Group A17—Domiciliary and residential medication management reviews

Column 1

Item

Column 2

Description

Column 3

Fee ($)

900

Participation by a general practitioner (not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for a patient living in a community setting, in which the general practitioner, with the patient’s consent:

(a) assesses the patient as:

(i) having a chronic medical condition or a complex medication regimen; and

(ii) not having their therapeutic goals met; and

(b) following that assessment:

(i) refers the patient to a community pharmacy or an accredited pharmacist for the DMMR; and

(ii) provides relevant clinical information required for the DMMR; and

(c) discusses with the reviewing pharmacist the results of the DMMR including suggested medication management strategies; and

(d) develops a written medication management plan following discussion with the patient; and

(e) provides the written medication management plan to a community pharmacy chosen by the patient

For any particular patient—applicable not more than once in each 12 month period, except if there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR

159.65

903

Participation by a general practitioner (not including a specialist or consultant physician) in a residential medication management review (RMMR) for a patient who is a care recipient in a residential aged care facility—other than an RMMR for a resident in relation to whom, in the preceding 12 months, this item has applied, unless there has been a significant change in the resident’s medical condition or medication management plan requiring a new RMMR

109.30

 

Division 2.18Group A30: Medical practitioner video conferencing consultation

2.18.1  Restrictions on items in Subgroups 1 and 2 of Group A30—services provided in association with certain other services

 (1) An item in Subgroup 1 or 2 of Group A30 applies if:

 (a) the service described in the item is provided in association with a service described in an item mentioned in subclause (2); and

 (b) no other service described in an item in Group A30 is provided to the patient on the same occasion; and

 (c) the medical practitioner providing clinical support to the patient is a general practitioner, specialist or consultant physician.

 (2) For the purposes of subclause (1), the items are 99, 112, 113, 114, 149, 288, 384, 389, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.

2.18.2  Location of attendance in items 2125, 2138, 2179 and 2220

  For items 2125, 2138, 2179 and 2220, professional attendance may be provided by the medical practitioner at consulting rooms in the residential aged care facility where the patient is a care recipient.

2.18.3  Meaning of amount under clause 2.18.3

  An amount under clause 2.18.3, for an item mentioned in column 1 of table 2.18.3, means the sum of:

 (a) the fee for the item mentioned in column 2 of that table; and

 (b) the fee for the item mentioned in:

 (i) if the medical practitioner attends no more than 6 patients in a single attendance—the amount mentioned in column 3 of that table, divided by the number of patients attended; or

 (ii) if the medical practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 4 of that table.

 

Table 2.18.3—Amount under clause 2.18.3

Item

Column 1

Item of this Schedule

Column 2

Fee

Column 3

Amount if not more than 6 patients (to be divided by the number of patients) ($)

Column 4

Amount per patient if more than 6 patients ($)

1

2122

The fee for item 2100

26.75

2.10

2

2125

The fee for item 2100

48.15

3.40

3

2137

The fee for item 2126

26.75

2.10

4

2138

The fee for item 2126

48.15

3.40

5

2147

The fee for item 2143

26.75

2.10

6

2179

The fee for item 2143

48.15

3.40

7

2199

The fee for item 2195

26.75

2.10

8

2220

The fee for item 2195

48.15

3.40

 

2.18.4  Restrictions on items in Subgroups 5 and 6 of Group A30 (video conferencing consultation attendances for patients in rural and remote areas)

  An item in Subgroup 5 or 6 of Group A30 applies to a professional attendance on a patient by a medical practitioner only if:

 (a) the patient is not an admitted patient; and

 (b) the patient is located within a Modified Monash 6 area or a Modified Monash 7 area; and

 (c) at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other; and

 (d) the patient has received 3 facetoface professional attendances from that practitioner in the preceding 12 months.

2.18.5  Items in Group A30

  This clause sets out items in Group A30.

 

Group A30—Medical practitioner video conferencing consultation

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Video conferencing consultation attendance at consulting rooms, home visit or other institution

2100

Professional attendance at consulting rooms lasting at least 5 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

 for which a direction made under subsection 19(2) of the Act applies

23.60

2122

Professional attendance not in consulting rooms lasting at least 5 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential aged care facility; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

2126

Professional attendance at consulting rooms lasting less than 20 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

51.50

2137

Professional attendance not in consulting rooms lasting less than 20 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential aged care facility; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

2143

Professional attendance at consulting rooms lasting at least 20 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

 for which a direction made under subsection 19(2) of the Act applies

99.90

2147

Professional attendance not in consulting rooms lasting at least 20 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential aged care facility; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

2195

Professional attendance at consulting rooms lasting at least 40 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

146.95

2199

Professional attendance not in consulting rooms lasting at least 40 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) is not a care recipient in a residential aged care facility; and

(d) is located both:

(i) within a telehealth eligible area; and

(ii) at the time of the attendance—at least 15 km by road from the specialist or physician mentioned in paragraph (a);

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

Subgroup 2—Video conferencing consultation attendance at a residential aged care facility

2125

Professional attendance lasting at least 5 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential aged care facility; and

(c) is not a resident of a selfcontained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

2138

Professional attendance lasting less than 20 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential aged care facility; and

(c) is not a resident of a selfcontained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

2179

Professional attendance lasting at least 20 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential aged care facility; and

(c) is not a resident of a selfcontained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

2220

Professional attendance lasting at least 40 minutes (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is a care recipient in a residential aged care facility; and

(c) is not a resident of a selfcontained unit;

for an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.18.3

Subgroup 5—General practitioner video conferencing consultation attendance for patients in rural and remote areas

2461

Professional attendance by video conference by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

17.75

2463

Professional attendance by video conference by a general practitioner, lasting less than 20 minutes, including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

38.75

2464

Professional attendance by video conference by a general practitioner, lasting at least 20 minutes but less than 40 minutes, including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

75.05

2465

Professional attendance by video conference by a general practitioner, lasting at least 40 minutes, including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

110.50

Subgroup 6—Other nonreferred video conferencing consultation attendance for patients in rural and remote areas

2471

Professional attendance by video conference lasting not more than 5 minutes by a medical practitioner who is not a general practitioner

11.15

2472

Professional attendance by video conference lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who is not a general practitioner

21.30

2475

Professional attendance by video conference lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who is not a general practitioner

38.55

2478

Professional attendance by video conference lasting more than 45 minutes by a medical practitioner who is not a general practitioner

61.90

 

Division 2.19Groups A18 and A19 (Attendances associated with Practice Incentive Program payments)

2.19.1  Restrictions on items in Subgroup 2 of Groups A18 and A19—timing

 (1) An item in Subgroup 2 of Group A18 or A19 does not apply to a service that is provided to a patient who has already been provided, in the previous 11 months, with another service described in that Subgroup.

 (2) For an item in Subgroup 2 of Group A18 or A19, a professional attendance completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus if the attendance completes a series of attendances that involve, over a period of at least 11 months and up to 13 months, (the current cycle), the following:

 (a) at least one assessment of the patient’s diabetes control, by measuring the patient’s HbA1c;

 (b) subject to subclause (3), if the patient has not had a comprehensive eye examination in the cycle of care ending immediately before the current cycle—at least one comprehensive eye examination;

 (c) measurement of the patient’s weight and height, and calculation of the patient’s BMI;

 (d) 2 further measurements of the patient’s weight with each measurement being taken at least 5 months after the previous measurement;

 (e) 2 measurements of the patient’s blood pressure, taken at least 5 months but not more than 7 months apart;

 (f) subject to subclause (3), 2 examinations of the patient’s feet, carried out at least 5 months but not more than 7 months apart;

 (g) at least one measurement of the patient’s total cholesterol, triglycerides and HDL cholesterol;

 (h) at least one test of the patient’s microalbuminuria;

 (i) at least one measurement of the patient’s estimated Glomerular Filtration Rate (eGFR);

 (j) provision to the patient of selfmanagement education regarding diabetes;

 (k) a review of the patient’s diet, and provision to the patient of information about appropriate dietary choices;

 (l) a review of the patient’s level of physical activity, and provision to the patient of information about the appropriate level of physical activity;

 (m) checking the patient’s tobacco smoking activity, and, if relevant, encouraging the patient to stop smoking;

 (n) a review of the patient’s medication.

 (3) For a patient with established diabetes mellitus who has a condition that is mentioned in table 2.19.1, the minimum requirements of a cycle of care for the patient in relation to paragraphs (2)(b) and (f) may be completed as set out in that table.

 

Table 2.19.1—Minimum requirements of a cycle of care

 

Column 1

Column 2

Item

Patient’s condition

How minimum requirements completed

1

A patient who is blind

Without an eye examination

2

A patient who has sight in only one eye

Examination of that eye

3

A patient who does not have any feet

Without a foot examination

4

A patient who has only one foot

Examination of that foot

 

2.19.2  Restrictions on items in Subgroup 3 of Groups A18 and A19—timing

 (1) An item in Subgroup 3 of Group A18 or A19 does not apply to a service that:

 (a) is provided to a patient who has already been provided, in the previous 12 months, with another service described in Subgroup 3 of Group A18 or A19; and

 (b) is not clinically indicated.

 (2) For an item in Subgroup 3 of Group A18 or A19, a professional attendance completes the minimum requirements of the Asthma Cycle of Care if the attendance completes a series of attendances that involves:

 (a) documented diagnosis and documented assessment of level of asthma control and severity of asthma; and

 (b) at least 2 asthmarelated consultations within 12 months (at least one of which (the review consultation) is a consultation that was planned at a previous consultation and includes the review mentioned in subparagraph (iv)) that involve the following for a patient with moderate to severe asthma:

 (i) a review of the patient’s use of and access to asthma related medication and devices;

 (ii) either:

 (A) provision to the patient of a written asthma action plan; or

 (B) if the patient is unable to use a written asthma action plan—discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient’s medical records;

 (iii) provision of asthma selfmanagement education to the patient;

 (iv) at the review consultation:

 (A) a review of the patient’s written or documented asthma action plan; and

 (B) if necessary, adjustment of that plan.

2.19.3  Items in Group A18

  This clause sets out items in Group A18.

 

Group A18—General practitioner attendances associated with Practice Incentives Program (PIP) payments

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Collection of a cervical screening specimen from an unscreened or significantly underscreened person

2497

Professional attendance at consulting rooms by a general practitioner:

(a) involving taking a short patient history and, if required, limited examination and management; and

(b) at which a specimen for a cervical screening service is collected from the patient;

if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years.

17.45

2501

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

38.20

2503

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Amount under clause 2.1.1

2504

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

73.95

2506

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Amount under clause 2.1.1

2507

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

108.85

2509

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Amount under clause 2.1.1

Subgroup 2—Completion of a cycle of care for patients with established diabetes mellitus

2517

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

38.20

2518

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Amount under clause 2.1.1

2521

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

73.95

2522

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Amount under clause 2.1.1

2525

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

108.85

2526

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Amount under clause 2.1.1

Subgroup 3—Completion of the minimum requirements of the Asthma Cycle of Care

2546

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

38.20

2547

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2552

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

73.95

2553

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2558

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

108.85

2559

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2.19.4  Items in Group A19

  This clause sets out items in Group A19.

 

Group A19—Other nonreferred attendances associated with Practice Incentives Program (PIP) payments to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Collection of a cervical screening specimen from an unscreened or significantly underscreened person

2598

Professional attendance at consulting rooms lasting less than 5 minutes by a medical practitioner who practices in general practice (other than a general practitioner) at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

11.00

2600

Professional attendance at consulting rooms lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

21.00

2603

Professional attendance at consulting rooms lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

38.00

2606

Professional attendance at consulting rooms lasting more than 45 minutes by a medical practitioner who practises in general practice (other than a general practitioner), at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

61.00

2610

Professional attendance at a place other than consulting rooms lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Amount under clause 2.1.1

2613

Professional attendance at a place other than consulting rooms lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Amount under clause 2.1.1

2616

Professional attendance at a place other than consulting rooms lasting more than 45 minutes by a medical practitioner who practises in general practice (other than a general practitioner), at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Amount under clause 2.1.1

Subgroup 2—Completion of a cycle of care for patients with established diabetes mellitus

2620

Professional attendance at consulting rooms lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

21.00

2622

Professional attendance at consulting rooms lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the requirements for a cycle of care of a patient with established diabetes mellitus

38.00

2624

Professional attendance at consulting rooms lasting more than 45 minutes by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

61.00

2631

Professional attendance at a place other than consulting rooms lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under clause 2.1.1

2633

Professional attendance at a place other than consulting rooms lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under clause 2.1.1

2635

Professional attendance at a place other than consulting rooms lasting more than 45 minutes by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus

Amount under clause 2.1.1

Subgroup 3—Completion of the minimum requirements of the Asthma Cycle of Care

2664

Professional attendance at consulting rooms lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

21.00

2666

Professional attendance at consulting rooms lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

38.00

2668

Professional attendance at consulting rooms lasting more than 45 minutes by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

61.00

2673

Professional attendance at a place other than consulting rooms lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2675

Professional attendance at a place other than consulting rooms lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

2677

Professional attendance at a place other than consulting rooms lasting more than 45 minutes by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Amount under clause 2.1.1

 

Division 2.20Group A20: Mental health care

2.20.1  Definitions

  In this Schedule:

focussed psychological strategies means any of the following mental health care management strategies which have been derived from evidencebased psychological therapies:

 (a) psychoeducation;

 (b) cognitivebehavioural therapy which involves cognitive or behavioural interventions;

 (c) relaxation strategies;

 (d) skills training;

 (e) interpersonal therapy;

 (f) eye movement desensitisation and reprocessing.

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; and

 (b) may be a recognised, medically diagnosable illness or disorder; and

 (c) is not dementia, delirium, tobacco use disorder or mental retardation.

Note: In relation to this definition, attention is drawn to the Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD10, Chapter 5, Primary Care Version), developed by the World Health Organisation and published in 1996.

outcome measurement tool means a tool used to monitor changes in a patient’s health that occur in response to treatment received by the patient.

2.20.2  Meaning of amount under clause 2.20.2

  In items 2723 and 2727:

amount under clause 2.20.2, for an item mentioned in column 1 of table 2.20.2, means the sum of:

 (a) the fee mentioned in column 2 for the item; and

 (b) either:

 (i) if not more than 6 patients are attended at a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

 (ii) if more than 6 patients are attended at a single attendance—the amount mentioned in column 4 for the item.

 

Table 2.20.2—Amount under clause 2.20.2

Item

Column 1

Item of this Schedule

Column 2

Fee

Column 3

Amount if not more than 6 patients (to be divided by the number of patients) ($)

Column 4

Amount if more than 6 patients ($)

1

2723

The fee for item 2721

26.75

2.10

2

2727

The fee for item 2725

26.75

2.10

 

2.20.3  Meaning of preparation of a GP mental health treatment plan

 (1) In this Schedule:

preparation of a GP mental health treatment plan, for a patient, means each of the following:

 (a) preparation of a written plan by a general practitioner for the patient that includes:

 (i) an assessment of the patient’s mental disorder, including administration of an outcome measurement tool (except if considered clinically inappropriate); and

 (ii) formulation of the mental disorder, including provisional diagnosis or diagnosis; and

 (iii) treatment goals with which the patient agrees; and

 (iv) any actions to be taken by the patient; and

 (v) a plan for either or both of the following:

 (A) crisis intervention;

 (B) relapse prevention; and

 (vi) referral and treatment options for the patient; and

 (vii) arrangements for providing the referral and treatment options mentioned in subparagraph (vi); and

 (viii) arrangements to review the plan;

 (b) explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan;

 (c) recording the plan;

 (d) recording the patient’s agreement to the preparation of the plan;

 (e) offering the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

 (i) a copy of the plan; and

 (ii) suitable education about the mental disorder;

 (f) adding a copy of the plan to the patient’s medical records.

 (2) In subparagraph (1)(a)(vi):

referral and treatment options, for a patient, includes:

 (a) support services for the patient; and

 (b) psychiatric services for the patient; and

 (c) subject to the applicable limitations:

 (i) psychological therapies provided to the patient by a clinical psychologist (items 80000 to 80020); and

 (ii) focussed psychological strategies services provided to the patient by a general practitioner mentioned in paragraph 2.20.7(1)(b) to provide those services (items 2721 to 2727); and

 (iii) focussed psychological strategies services provided to the patient by an allied mental health professional (items 80100 to 80170).

Note: For items 80000 to 80020 and 80100 to 80170, see the determination about allied health services under subsection 3C(1) of the Act.

2.20.4  Meaning of review of a GP mental health treatment plan

  In this Schedule:

review of a GP mental health treatment plan means a process by which a general practitioner:

 (a) reviews the matters mentioned in paragraph (a) of the definition of preparation of a GP mental health treatment plan in subclause 2.20.3(1); and

 (b) checks, reinforces and expands any education given under the plan; and

 (c) if appropriate and if not previously provided—prepares a plan for either or both of the following:

 (i) crisis intervention;

 (ii) relapse prevention;

 (d) readministers the outcome measurement tool used in the assessment mentioned in subparagraph (a)(i) of the definition of preparation of a GP mental health treatment plan in subclause 2.20.3(1) (except if considered clinically inappropriate); and

 (e) if different arrangements need to be made—makes amendments to the plan that state those new arrangements; and

 (f) explains to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review of the plan; and

 (g) records the patient’s agreement to the review of the plan; and

 (h) if amendments are made to the plan:

 (i) offers a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

 (ii) adds a copy of the amended plan to the patient’s medical records.

2.20.5  Meaning of associated general practitioner

  In item 2712:

associated general practitioner means a general practitioner (not including a specialist or consultant physician) who, if not engaged in the same general practice as the general practitioner mentioned in that item, performs the service described in the item at the request of the patient (or the patient’s guardian).

2.20.6  Restrictions on items in Subgroup 1 of Group A20 (GP mental health treatment plans)

Patients provided with certain services

 (1) Items 2700, 2701, 2712, 2713, 2715 and 2717 apply only to a patient with a mental disorder.

 (2) Items 2700, 2701, 2712, 2715 and 2717 apply only to:

 (a) a patient in the community; and

 (b) a private inpatient (including a private inpatient who is a resident of an aged care facility) being discharged from hospital; and

 (c) a service provided in the course of personal attendance by a single general practitioner on a single patient.

Timing of certain services

 (3) Unless exceptional circumstances exist, items 2700, 2701, 2715 and 2717 cannot be claimed:

 (a) with a service to which items 735 to 758, or item 2713 apply; or

 (b) more than once in a 12 month period from the provision of any of the items for a particular patient.

Item 2712

 (4) Item 2712 applies only if one of the following services has been provided to the patient:

 (a) the preparation of a GP mental health treatment plan under items 2700, 2701, 2715 and 2717;

 (b) a psychiatrist assessment and management plan under item 291.

 (5) Item 2712 does not apply:

 (a) to a service to which items 735 to 758, or item 2713 apply; or

 (b) unless exceptional circumstances exist for the provision of the service:

 (i) more than once in a 3 month period; or

 (ii) within 4 weeks following the preparation of a GP mental health treatment plan (item 2700, 2701, 2715 or 2717).

Item 2713

 (7) Item 2713 does not apply in association with a service to which item 2700, 2701, 2715, 2717 or 2712 applies.

Items 2715 and 2717—practitioner training

 (8) Items 2715 and 2717 apply only if the general practitioner providing the service has successfully completed mental health skills training accredited by the General Practice Mental Health Standards Collaboration.

Note: The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

Definition

 (9) In this clause:

exceptional circumstances means a significant change in:

 (a) the patient’s clinical condition; or

 (b) the patient’s care circumstances.

2.20.7  Restrictions on items in Subgroup 2 of Group A20 (focussed psychological strategies)

 (1) An item in Subgroup 2 of Group A20 applies to a service which:

 (a) is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

 (b) is provided by a general practitioner:

 (i) whose name is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017; and

 (ii) who is identified in the register as a medical practitioner who can provide services to which Subgroup 2 of Group A20 applies; and

 (iii) who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 applies.

 (2) An item in Subgroup 2 of Group A20 does not apply to:

 (a) a service which:

 (i) is provided to a patient who, in a calendar year, has already been provided with 6 services to which any of the items in Subgroup 2 applies; and

 (ii) is provided before the medical practitioner managing the GP mental health treatment plan or the psychiatrist assessment and management plan has conducted a patient review and recorded in the patient’s records a recommendation that the patient have additional sessions of focussed psychological strategies in the same calendar year; or

 (b) a service which is provided to a patient who has already been provided, in the calendar year, with 10 other services to which any of the items in Subgroup 2, or items 80000 to 80015, 80100 to 80115, 80125 to 80140 or 80150 to 80165 apply.

Note: For items 80000 to 80015, 80100 to 80115, 80125 to 80140 and 80150 to 80165, see the determination about allied health services under subsection 3C(1) of the Act.

2.20.8  Items in Group A20

  This clause sets out items in Group A20.

 

Group A20—Mental health care

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—GP mental health treatment plans

2700

Professional attendance, by a general practitioner who has not undertaken mental health skills training (and not including a specialist or consultant physician), lasting at least 20 minutes, but less than 40 minutes, for the preparation of a GP mental health treatment plan for a patient

73.95

2701

Professional attendance, by a general practitioner who has not undertaken mental health skills training (and not including a specialist or consultant physician), lasting at least 40 minutes for the preparation of a GP mental health treatment plan for a patient

108.85

2712

Professional attendance by a general practitioner (not including a specialist or consultant physician) to review a GP mental health treatment plan which the general practitioner, or an associated general practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan

73.95

2713

Professional attendance at consulting rooms by a general practitioner (not including a specialist or consultant physician) in relation to a mental disorder and lasting at least 20 minutes, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation

73.95

2715

Professional attendance, by a general practitioner who has undertaken mental health skills training (but not including a specialist or consultant physician), lasting at least 20 minutes, but less than 40 minutes, for the preparation of a GP mental health treatment plan for a patient

93.90

2717

Professional attendance, by a general practitioner who has undertaken mental health skills training (but not including a specialist or consultant physician), lasting at least 40 minutes for the preparation of a GP mental health treatment plan for a patient

138.30

Subgroup 2—Focussed psychological strategies

2721

Professional attendance at consulting rooms by a general practitioner (not including a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

95.65

2723

Professional attendance at a place other than consulting rooms by a general practitioner (not including a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes

Amount under clause 2.20.2

2725

Professional attendance at consulting rooms by a general practitioner (not including a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

136.85

2727

Professional attendance at a place other than consulting rooms by a general practitioner (not including a specialist or a consultant physician), for providing focussed psychological strategies for assessed mental disorders by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes

Amount under clause 2.20.2

 

Division 2.21Group A24: Palliative and pain medicine

2.21.1  Meaning of organise and coordinate

  In the items in Subgroups 2 and 4 of Group A24:

organise and coordinate, for a conference mentioned in the item, means undertaking all of the following activities:

 (a) explaining to the patient the nature of the conference;

 (b) asking the patient whether the patient agrees to the conference taking place;

 (c) recording the patient’s agreement to the conference;

 (d) recording the day the conference was held and the times the conference started and ended;

 (e) recording the names of the participants;

 (f) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records;

 (g) offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

 (h) discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

2.21.2  Meaning of participate

  In items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088 and 3093:

participate, for a conference mentioned in the item, means participation that:

 (a) if the conference is a community case conference—is at the request of the person who organises and coordinates the conference; and

 (b) involves undertaking all of the following activities in relation to the conference:

 (i) explaining to the patient the nature of the conference;

 (ii) asking the patient whether the patient agrees to the practitioner’s participation in the conference;

 (iii) recording the patient’s agreement to the practitioner’s participation in the conference;

 (iv) recording the day the conference was held and the times the conference started and ended;

 (v) recording the names of the participants;

 (vi) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records; but

 (c) if the conference is a community case conference—does not include organising and coordinating the conference.

2.21.3  Restrictions on items in Subgroups 2 and 4 of Group A24—timing

  The items in Subgroups 2 and 4 of Group A24 may only apply to a patient 5 times in a 12 month period.

2.21.4  Items in Group A24

  This clause sets out items in Group A24.

 

Group A24—Palliative and pain medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Pain medicine attendances

2799

Initial professional attendance lasting 10 minutes or less on a patient by a specialist or consultant physician practising in the specialist’s or consultant physician’s specialty of pain medicine if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

118.50

2801

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—initial attendance in a single course of treatment

157.95

2806

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance (other than a service to which item 2814 applies) after the initial attendance in a single course of treatment

79.05

2814

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—minor attendance

45.00

2820

Professional attendance on a patient by a specialist or consultant physician practising in the specialist’s or consultant physician’s specialty of pain medicine if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 2801 lasting more than 10 minutes; or

(ii) provided with item 2806 or 2814; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 2801, 2806 or 2814

2824

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—initial attendance in a single course of treatment

191.65

2832

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance (other than a service to which item 2840 applies) after the initial attendance in a single course of treatment

115.90

2840

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—minor attendance

83.50

Subgroup 2—Pain medicine case conferences

2946

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes

145.60

2949

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes

218.50

2954

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 45 minutes

291.10

2958

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes

104.55

2972

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes

166.75

2974

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes

229.00

2978

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

145.60

2984

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

218.50

2988

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, before the patient is discharged from a hospital (H)

291.10

2992

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

104.55

2996

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

166.75

3000

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of pain medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 45 minutes, before the patient is discharged from a hospital (H)

229.00

Subgroup 3—Palliative medicine attendances

3003

Initial professional attendance lasting 10 minutes or less on a patient by a specialist or consultant physician practising in the specialist’s or consultant physician’s specialty of palliative medicine if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

118.50

3005

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—initial attendance in a single course of treatment

157.95

3010

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance (other than a service to which item 3014 applies) after the initial attendance in a single course of treatment

79.05

3014

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—minor attendance

45.00

3015

Professional attendance on a patient by a specialist or consultant physician practising in the specialist’s or consultant physician’s specialty of palliative medicine if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 3005 lasting more than 10 minutes; or

(ii) provided with item 3010 or 3014; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist or physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 3005, 3010 or 3014

3018

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—initial attendance in a single course of treatment

191.65

3023

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance (other than a service to which item 3028 applies) after the initial attendance in a single course of treatment

115.90

3028

Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner—minor attendance

83.50

Subgroup 4—Palliative medicine case conferences

3032

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes

145.60

3040

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes

218.50

3044

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a community case conference of at least 45 minutes

291.10

3051

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes

104.55

3055

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines

166.75

3062

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes

229.00

3069

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

145.60

3074

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

218.50

3078

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, before the patient is discharged from a hospital (H)

291.10

3083

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, before the patient is discharged from a hospital (H)

104.55

3088

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, before the patient is discharged from a hospital (H)

166.75

3093

Attendance by a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty of palliative medicine, as a member of a multidisciplinary case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference) of at least 45 minutes, before the patient is discharged from a hospital (H)

229.00

 

Division 2.22Group A27: Pregnancy support counselling

2.22.1  Restrictions on item 4001

 (1) A service to which item 4001 applies must not be provided by a general practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

 (2) Item 4001 does not apply if a patient has already been provided, for the same pregnancy, with 3 services to which that item or item 81000, 81005 or 81010 applies.

Note: For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.

 (3) In item 4001:

nondirective pregnancy support counselling means counselling provided by a general practitioner to a person in which:

 (a) information and issues relating to pregnancy are discussed; and

 (b) the general practitioner does not impose the general practitioner’s views or values about what the person should or should not do in relation to the pregnancy.

 (4) A service to which item 4001 applies may be used to address any pregnancyrelated issue.

2.22.2  Items in Group A27

  This clause sets out items in Group A27.

 

Group A27—Pregnancy support counselling

Column 1

Item

Column 2

Description

Column 3

Fee ($)

4001

Professional attendance lasting at least 20 minutes at consulting rooms by a general practitioner (not including a specialist or consultant physician) who is registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service for the purpose of providing nondirective pregnancy support counselling to a person who:

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 81000, 81005 or 81010 applies in relation to that pregnancy

Note: For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.

79.00

 

Division 2.23Group A21: Professional attendances at recognised emergency departments of private hospitals

2.23.1  Items in Group A21

  This clause sets out items in Group A21.

 

Group A21—Professional attendances at recognised emergency departments of private hospitals

Column 1

Item

Column 2

Description

Column 3

Fee ($)

5001

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of ordinary complexity

60.50

5004

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of ordinary complexity

101.60

5011

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of ordinary complexity

101.60

5012

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of complexity that is more than ordinary but is not high

159.25

5013

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of complexity that is more than ordinary but is not high

200.35

5014

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of complexity that is more than ordinary but is not high

200.35

5016

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of high complexity

268.85

5017

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of high complexity

310.00

5019

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decisionmaking of high complexity

310.00

5021

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of ordinary complexity

45.35

5022

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of ordinary complexity

76.20

5027

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of ordinary complexity

76.20

5030

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of complexity that is more than ordinary but is not high

119.40

5031

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of complexity that is more than ordinary but is not high

150.25

5032

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of complexity that is more than ordinary but is not high

150.25

5033

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of high complexity

201.65

5035

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of high complexity

232.50

5036

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decisionmaking of high complexity

232.50

5039

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine for preparation of goals of care by the specialist for a gravely ill patient lacking current goals of care if:

(a) the specialist takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the initial attendance by the specialist for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is in conjunction with, or after, an attendance on the patient by the specialist that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019

146.95

5041

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine for preparation of goals of care by the specialist for a gravely ill patient lacking current goals of care if:

(a) the specialist takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the initial attendance by the specialist for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is not in conjunction with, or after, an attendance on the patient by the specialist that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019; and

(d) the attendance is for at least 60 minutes

276.25

5042

Professional attendance at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) for preparation of goals of care by the practitioner for a gravely ill patient lacking current goals of care if:

(a) the practitioner takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the initial attendance by the practitioner for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is in conjunction with, or after, an attendance on the patient by the practitioner that is described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036

110.25

5044

Professional attendance at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) for preparation of goals of care by the practitioner for a gravely ill patient lacking current goals of care if:

(a) the practitioner takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the initial attendance by the practitioner for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is not in conjunction with, or after, an attendance on the patient by the practitioner that is described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(d) the attendance is for at least 60 minutes

207.15

Division 2.24Group A22: General practitioner afterhours attendances to which no other item applies

2.24.1  Restrictions on items in Group A22—timing

 (1) Items 5000, 5020, 5040 and 5060 apply only to a professional attendance that is provided:

 (a) on a public holiday; or

 (b) on a Sunday; or

 (c) before 8 am, or after 1 pm, on a Saturday; or

 (d) before 8 am, or after 8 pm, on a day other than a day mentioned in paragraphs (a) to (c).

 (2) Items 5003, 5010, 5023, 5028, 5043, 5049, 5063 and 5067 apply only to a professional attendance that is provided in an afterhours period.

2.24.2  Items in Group A22

  This clause sets out items in Group A22.

 

Group A22—General practitioner afterhours attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

5000

Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

29.90

5003

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies) that requires a short patient history and, if necessary, limited examination and management—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5010

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5020

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

50.55

5023

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5028

Professional attendance by a general practitioner (other than a service to which another item in this Schedule applies), on care recipients in a residential aged care facility, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5040

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

86.60

5043

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5049

Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item in this Schedule applies, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5060

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation

121.45

5063

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5067

Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item in this Schedule applies, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

 

Division 2.25Group A23: Other nonreferred afterhours attendances to which no other item applies

2.25.1  Restrictions on items in Group A23—timing

 (1) Items 5200, 5203, 5207 and 5208 apply only to a professional attendance that is provided:

 (a) on a public holiday; or

 (b) on a Sunday; or

 (c) before 8 am, or after 1 pm, on a Saturday; or

 (d) before 8 am, or after 8 pm, on a day other than a day mentioned in paragraphs (a) to (c).

 (2) Items 5220 to 5267 apply only to a professional attendance that is provided in an afterhours period.

2.25.2  Items in Group A23

  This clause sets out items in Group A23.

 

Group A23—Other nonreferred afterhours attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

5200

Professional attendance at consulting rooms lasting not more than 5 minutes (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)

21.00

5203

Professional attendance at consulting rooms lasting more than 5 minutes, but not more than 25 minutes, (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)

31.00

5207

Professional attendance at consulting rooms lasting more than 25 minutes, but not more than 45 minutes, (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)

48.00

5208

Professional attendance at consulting rooms lasting more than 45 minutes (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)

71.00

5220

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting not more than 5 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5223

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting more than 5 minutes, but not more than 25 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5227

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting more than 25 minutes, but not more than 45 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5228

Professional attendance by a medical practitioner who is not a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting more than 45 minutes—an attendance on one or more patients on one occasion—each patient

Amount under clause 2.1.1

5260

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting not more than 5 minutes by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5263

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting more than 5 minutes, but not more than 25 minutes, by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5265

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting more than 25 minutes, but not more than 45 minutes, by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

5267

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting more than 45 minutes by a medical practitioner (other than a general practitioner)—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

Division 2.26Group A26: Neurosurgery attendances to which no other item applies

2.26.1  Items in Group A26

  This clause sets out items in Group A26.

 

Group A26—Neurosurgery attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

6004

Initial professional attendance lasting 10 minutes or less on a patient by a specialist practising in the specialist’s specialty of neurosurgery if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

101.75

6007

Professional attendance by a specialist practising in the specialist’s specialty of neurosurgery following referral of the patient to the specialist—an initial attendance in a single course of treatment at consulting rooms or hospital

135.65

6009

Professional attendance by a specialist practising in the specialist’s specialty of neurosurgery following referral of the patient to the specialist—minor attendance at consulting rooms or hospital

45.00

6011

Professional attendance by a specialist practising in the specialist’s specialty of neurosurgery following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, involving an extensive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and lasting more than 15 minutes, but not more than 30 minutes, at consulting rooms or hospital

89.55

6013

Professional attendance by a specialist practising in the specialist’s specialty of neurosurgery following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, involving a detailed and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and lasting more than 30 minutes, but not more than 45 minutes, at consulting rooms or hospital

124.05

6015

Professional attendance by a specialist practising in the specialist’s specialty of neurosurgery following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, involving an exhaustive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and lasting more than 45 minutes at consulting rooms or hospital

157.95

6016

Professional attendance on a patient by a specialist practising in the specialist’s specialty of neurosurgery if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 6007 lasting more than 10 minutes; or

(ii) provided with item 6009, 6011, 6013 or 6015; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 6007, 6009, 6011, 6013 or 6015

 

Division 2.27Group A31: Addiction medicine

2.27.1  Meaning of organise and coordinate

  In items 6029 to 6042:

organise and coordinate, for a conference mentioned in the item, means undertaking all of the following activities:

 (a) explaining to the patient the nature of the conference;

 (b) asking the patient whether the patient agrees to the conference taking place;

 (c) recording the patient’s agreement to the conference;

 (d) recording the day the conference was held and the times the conference started and ended;

 (e) recording the names of the participants;

 (f) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records;

 (g) offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

 (h) discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

2.27.2  Meaning of participate

  In items 6035 to 6042:

participate, for a conference mentioned in the item, means participation that:

 (a) does not include organising and coordinating the conference; and

 (b) involves undertaking all of the following activities in relation to the conference:

 (i) explaining to the patient the nature of the conference;

 (ii) asking the patient whether the patient agrees to the practitioner’s participation in the conference;

 (iii) recording the patient’s agreement to the practitioner’s participation in the conference;

 (iv) recording the day the conference was held and the times the conference started and ended;

 (v) recording the names of the participants;

 (vi) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records.

2.27.3  Restrictions on item 6028

  Item 6028 applies only to a service provided in the course of a personal attendance by a single addiction medicine specialist.

2.27.4  Items in Group A31

  This clause sets out items in Group A31.

 

Group A31—Addiction medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Addiction medicine attendances

6018

Professional attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty following referral of the patient to the addiction medicine specialist by a referring practitioner, if the attendance:

(a) includes a comprehensive assessment; and

(b) is the first or only time in a single course of treatment that a comprehensive assessment is provided

157.95

6019

Professional attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty following referral of the patient to the addiction medicine specialist by a referring practitioner, if the attendance is a patient assessment:

(a) before or after a comprehensive assessment under item 6018 in a single course of treatment; or

(b) that follows an initial assessment under item 6023 in a single course of treatment; or

(c) that follows a review under item 6024 in a single course of treatment

79.05

6023

Professional attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty of at least 45 minutes for an initial assessment of a patient with at least 2 morbidities, following referral of the patient to the addiction medicine specialist by a referring practitioner, if:

(a) an assessment is undertaken that covers:

(i) a comprehensive history, including psychosocial history and medication review; and

(ii) a comprehensive multi or detailed single organ system assessment; and

(iii) the formulation of differential diagnoses; and

(b) an addiction medicine specialist treatment and management plan of significant complexity that includes the following is prepared and provided to the referring practitioner:

(i) an opinion on diagnosis and risk assessment;

(ii) treatment options and decisions;

(iii) medication recommendations; and

(c) an attendance on the patient to which item 104, 105, 110, 116, 119, 132, 133, 6018 or 6019 applies did not take place on the same day by the same addiction medicine specialist; and

(d) neither this item nor item 132 has applied to an attendance on the patient in the preceding 12 months by the same addiction medicine specialist

276.25

6024

Professional attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty of at least 20 minutes, after the initial attendance in a single course of treatment for a review of a patient with at least 2 morbidities if:

(a) a review is undertaken that covers:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(b) the modified addiction medicine specialist treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

(i) a revised opinion on diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

(c) an attendance on the patient to which item 104, 105, 110, 116, 119, 132, 133, 6018 or 6019 applies did not take place on the same day by the same addiction medicine specialist; and

(d) item 6023 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same addiction medicine specialist who claimed item 6023 or by a locum tenens; and

(f) this item has not applied more than twice in any 12 month period

138.30

6025

Initial professional attendance of 10 minutes or less, on a patient by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the addiction medicine specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

118.50

6026

Professional attendance on a patient by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 6018 or 6019 and lasting more than 10 minutes; or

(ii) provided with item 6023 or 6024; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the addiction medicine specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19 (2) of the Act applies

50% of the fee for item 6018, 6019, 6023 or 6024

Subgroup 2—Group therapy

6028

Group therapy (including any associated consultation with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour, given under the continuous direct supervision of an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty for a group of 2 to 9 unrelated patients, or a family group of more than 2 patients, each of whom is referred to the addiction medicine specialist by a referring practitioner—for each patient

51.60

Subgroup 3—Addiction medicine case conferences

6029

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of less than 15 minutes, with the multidisciplinary case conference team

44.70

6031

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with the multidisciplinary case conference team

79.05

6032

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

118.60

6034

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate the multidisciplinary case conference of at least 45 minutes, with the multidisciplinary case conference team

157.95

6035

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of less than 15 minutes, with the multidisciplinary case conference team

35.75

6037

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, with the multidisciplinary case conference team

63.25

6038

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

94.85

6042

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes, with the multidisciplinary case conference team

126.35

 

Division 2.28Group A32: Sexual health medicine

2.28.1  Meaning of organise and coordinate

  In items 6064 to 6075:

organise and coordinate, for a conference mentioned in the item, means undertaking all of the following activities:

 (a) explaining to the patient the nature of the conference;

 (b) asking the patient whether the patient agrees to the conference taking place;

 (c) recording the patient’s agreement to the conference;

 (d) recording the day the conference was held and the times the conference started and ended;

 (e) recording the names of the participants;

 (f) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records;

 (g) offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

 (h) discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

2.28.2  Meaning of participate

  In items 6071 to 6075:

participate, for a conference mentioned in the item, means participation that:

 (a) does not include organising and coordinating the conference; and

 (b) involves undertaking all of the following activities in relation to the conference:

 (i) explaining to the patient the nature of the conference;

 (ii) asking the patient whether the patient agrees to the practitioner’s participation in the conference;

 (iii) recording the patient’s agreement to the practitioner’s participation in the conference;

 (iv) recording the day the conference was held and the times the conference started and ended;

 (v) recording the names of the participants;

 (vi) recording the activities mentioned in the definition of multidisciplinary case conference in clause 1.1.4 and putting a copy of that record in the patient’s medical records.

2.28.3  Items in Group A32

  This clause sets out items in Group A32.

 

Group A32—Sexual health medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Sexual health medicine attendances

6051

Professional attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty following referral of the patient to the sexual health medicine specialist by a referring practitioner, if the attendance:

(a) includes a comprehensive assessment; and

(b) is the first or only time in a single course of treatment that a comprehensive assessment is provided

157.95

6052

Professional attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty following referral of the patient to the sexual health medicine specialist by a referring practitioner, if the attendance is a patient assessment:

(a) before or after a comprehensive assessment under item 6051 in a single course of treatment; or

(b) that follows an initial assessment under item 6057 in a single course of treatment; or

(c) that follows a review under item 6058 in a single course of treatment

79.05

6057

Professional attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty of at least 45 minutes for an initial assessment of a patient with at least 2 morbidities, following referral of the patient to the sexual health medicine specialist by a referring practitioner, if:

(a) an assessment is undertaken that covers:

(i) a comprehensive history, including psychosocial history and medication review; and

(ii) a comprehensive multi or detailed single organ system assessment; and

(iii) the formulation of differential diagnoses; and

(b) a sexual health medicine specialist treatment and management plan of significant complexity that includes the following is prepared and provided to the referring practitioner:

(i) an opinion on diagnosis and risk assessment;

(ii) treatment options and decisions;

(iii) medication recommendations; and

(c) an attendance on the patient to which item 104, 105, 110, 116, 119, 132, 133, 6051 or 6052 applies did not take place on the same day by the same sexual health medicine specialist; and

(d) neither this item nor item 132 has applied to an attendance on the patient in the preceding 12 months by the same sexual health medicine specialist

276.25

6058

Professional attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty of at least 20 minutes, after the initial attendance in a single course of treatment for a review of a patient with at least 2 morbidities if:

(a) a review is undertaken that covers:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(b) the modified sexual health medicine specialist treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

(i) a revised opinion on diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

(c) an attendance on the patient, being an attendance to which item 104, 105, 110, 116, 119, 132, 133, 6051 or 6052 applies did not take place on the same day by the same sexual health medicine specialist; and

(d) item 6057 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same sexual health medicine specialist who claimed item 6057 or by a locum tenens; and

(f) this item has not applied more than twice in any 12 month period

138.30

6059

Initial professional attendance of 10 minutes or less, on a patient by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the sexual health medicine specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

118.50

6060

Professional attendance on a patient by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 6051 or 6052 and lasting more than 10 minutes; or

(ii) provided with item 6057 or 6058; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the sexual health medicine specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19 (2) of the Act applies

50% of the fee for item 6051, 6052, 6057 or 6058

Subgroup 2—Home visits

6062

Professional attendance at a place other than consulting rooms or a hospital by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty following referral of the patient to the sexual health medicine specialist by a referring practitioner—initial attendance in a single course of treatment

191.65

6063

Professional attendance at a place other than consulting rooms or a hospital by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty following referral of the patient to the sexual health medicine specialist by a referring practitioner—an attendance after the attendance under item 6062 in a single course of treatment

115.90

Subgroup 3—Sexual health medicine case conferences

6064

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of less than 15 minutes, with the multidisciplinary case conference team

44.70

6065

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with the multidisciplinary case conference team

79.05

6067

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

118.60

6068

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of at least 45 minutes, with the multidisciplinary case conference team

157.95

6071

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of less than 15 minutes, with the multidisciplinary case conference team

35.75

6072

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 15 minutes but less than 30 minutes, with the multidisciplinary case conference team

63.25

6074

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

94.85

6075

Attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist’s specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to participate in a community case conference (other than to organise and coordinate the conference) of at least 45 minutes, with the multidisciplinary case conference team

126.35

Division 2.29Group A9: Contact lenses

2.29.1  Restrictions on item 10809

  Item 10809 does not apply if the patient’s requirement for contact lenses is only for any of the following reasons:

 (a) because the patient does not want to wear spectacles for reasons of appearance;

 (b) because the patient wants contact lenses for work or sporting purposes;

 (c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.

2.29.2  Items in Group A9

  This clause sets out items in Group A9.

 

Group A9—Contact lenses

Column 1

Item

Column 2

Description

Column 3

Fee ($)

10801

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with myopia of 5.0 dioptres or greater (spherical equivalent) in one eye

127.35

10802

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in one eye

127.35

10803

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with astigmatism of 3.0 dioptres or greater in one eye

127.35

10804

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens

127.35

10805

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)

127.35

10806

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes and for whom a contact lens is prescribed as part of a telescopic system

127.35

10807

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin

127.35

10808

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient who, because of physical deformity, are unable to wear spectacles

127.35

10809

Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—one service in any period of 36 months—patient with a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10806, 10807 or 10808 applies) requiring the use of a contact lens for correction, if the condition is specified on the patient’s account

127.35

10816

Attendance for the refitting of contact lenses with keratometry and testing with trial lenses and the issue of a prescription, if the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structural or functional change in the eye or an allergic response within 36 months after the fitting of a contact lens to which items 10801 to 10809 apply

127.35

 

Division 2.30Group A35: Nonreferred attendance at a residential aged care facility

2.30.1  Fee in relation to the first patient during each attendance at a residential aged care facility

 (1) For the first patient attended during one attendance by a general practitioner at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 90020, 90035, 90043 or 90051 applies is the amount listed in the item plus $56.75.

 (2) For the first patient attended during one attendance by a medical practitioner at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 90092, 90093, 90095 or 90096 applies is the amount listed in the item plus $41.25.

2.30.2  Items in Group A35

  This clause sets out items in Group A35.

 

Group A35—Nonreferred attendance at a residential aged care facility

Column 1

Item

Column 2

Description

Column 3

Fee ($)

90020

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1)

17.75

90035

Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item applies, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1)

38.75

90043

Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item applies, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1)

75.05

90051

Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item applies, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more healthrelated issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1)

110.50

90092

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting not more than 5 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1), by a medical practitioner who is not a general practitioner

8.50

90093

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting more than 5 minutes, but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1), by a medical practitioner who is not a general practitioner

16.00

90095

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting more than 25 minutes, but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1), by a medical practitioner who is not a general practitioner

35.50

90096

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a selfcontained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is a care recipient in the facility who is not a resident of a selfcontained unit, lasting more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1), by a medical practitioner who is not a general practitioner

57.50

 

Part 3Miscellaneous services

Division 3.1Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

3.1.1  Definitions for item 10997

  In item 10997:

GP management plan means a plan under item 721 or 732 (for coordination of a review of a GP management plan under item 721).

multidisciplinary care plan means a plan under item 729 or 731.

person with a chronic disease means a person who has a care plan under item 721, 723, 729, 731 or 732.

3.1.2  Restrictions on item 10988

 (1) Item 10988 applies to an immunisation provided to a person by an Aboriginal and Torres Strait Islander health practitioner only if:

 (a) the Aboriginal and Torres Strait Islander health practitioner is appropriately qualified and trained to provide immunisations to persons; and

 (b) the medical practitioner under whose supervision the immunisation is provided retains responsibility for the health, safety and clinical outcomes of the person.

 (2) If the cost of the vaccine supplied in connection with a service described in item 10988 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that vaccine.

3.1.3  Restrictions on item 10989

  Item 10989 applies to an Aboriginal and Torres Strait Islander health practitioner if:

 (a) the health practitioner is appropriately qualified and trained to treat wounds; and

 (b) a medical practitioner under whose supervision the health practitioner provides the treatment has conducted an initial assessment of the person; and

 (c) the health practitioner has been instructed by the medical practitioner about the treatment of the wound; and

 (d) the medical practitioner retains responsibility for the health, safety and clinical outcomes of the person.

3.1.4  Items in Group M12

  This clause sets out items in Group M12.

 

Group M12—Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Video conferencing consultation support service provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

10983

Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner, to provide clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist, physician or psychiatrist mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

33.40

Subgroup 2—Video conferencing consultation support service provided at a residential aged care facility on behalf of a medical practitioner

10984

Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner, to provide clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist; and

(b) is a care recipient in a residential aged care facility; and

(c) is not a resident of a selfcontained unit

33.40

Subgroup 3—Services provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner

10987

Followup service, to a maximum of 10 services per patient in a calendar year, provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health check if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person is not an admitted patient of a hospital; and

(c) the service is consistent with the needs identified through the health assessment

24.75

10988

Immunisation provided to a person by an Aboriginal and Torres Strait Islander health practitioner if:

(a) the immunisation is provided on behalf of, and under the supervision of, a medical practitioner; and

(b) the person is not an admitted patient of a hospital

12.40

10989

Treatment of a person’s wound (other than normal aftercare) provided by an Aboriginal and Torres Strait Islander health practitioner if:

(a) the treatment is provided on behalf of, and under the supervision of, a medical practitioner; and

(b) the person is not an admitted patient of a hospital

12.40

10997

Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic disease, to a maximum of 5 services for the person in a calendar year, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person is not an admitted patient of a hospital; and

(c) the person has a GP management plan, team care arrangements or multidisciplinary care plan in place and the service is consistent with the plan or arrangements

12.40

 

Division 3.2Group M1: Management of bulkbilled services

3.2.1  Definitions

  In this Division:

ASGC means the July 2011 edition of the Australian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician, as existing on 1 July 2020.

bulkbilled: a medical service is bulkbilled 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 medical 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 medical practitioner accepts the assignment in full payment of the medical practitioner’s fee for the service provided.

concessional beneficiary has the same meaning as in Part VII of the National Health Act 1953.

designated area means the following:

 (a) a regional, rural or remote area;

 (b) Tasmania;

 (c) a geographical area included in any of the following SSD spatial units:

 (i) Beaudesert Shire Part A;

 (ii) Belconnen;

 (iii) Darwin City;

 (iv) Eastern Outer Melbourne;

 (v) East Metropolitan Perth;

 (vi) Frankston City;

 (vii) GosfordWyong;

 (viii) Greater Geelong City Part A;

 (ix) GungahlinHall;

 (x) Ipswich City (Part in BSD);

 (xi) Litchfield Shire;

 (xii) MeltonWyndham;

 (xiii) Mornington Peninsula Shire;

 (xiv) Newcastle;

 (xv) North Canberra;

 (xvi) PalmerstonEast Arm;

 (xvii) Pine Rivers Shire;

 (xviii) Queanbeyan;

 (xix) South Canberra;

 (xx) South Eastern Outer Melbourne;

 (xxi) Southern Adelaide;

 (xxii) South West Metropolitan Perth;

 (xxiii) Thuringowa City Part A;

 (xxiv) Townsville City Part A;

 (xxv) Tuggeranong;

 (xxvi) Weston CreekStromlo;

 (xxvii) Woden Valley;

 (xxviii) Yarra Ranges Shire Part A;

 (d) the geographical area included in the SLA spatial unit of Palm Island (AC).

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

unreferred service means a medical service provided by, or on behalf of, a medical practitioner to a patient who has not been referred to the practitioner for the service.

3.2.2  Restrictions on items 10990, 10991 and 10992

 (1) If the medical service described in item 10991 is provided to a person, either that item or 10990, but not both those items, applies to the service.

 (2) If the medical service described in item 10992 is provided to a person, either that item or 10990, but not both those items, applies to the service.

 (3) If item 10990, 10991 or 10992 applies to a medical service, the fee mentioned in that item applies in addition to the fee mentioned in another item in this Schedule that applies to the service.

3.2.3  Items in Group M1

  This clause sets out items in Group M1.

 

Group M1—Management of bulkbilled services

Column 1

Item

Column 2

Description

Column 3

Fee ($)

10990

A medical service to which an item in this Schedule (other than this item or item 10991 or 10992) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service

15.20

10991

A medical service to which an item in this Schedule (other than this item or item 10990 or 10992) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in:

(i) a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area

23.05

10992

A medical service to which:

(a) item 585, 588, 591, 594, 599, 600, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 or 5267 applies; or

(b) item 761, 763, 766, 769, 772, 776, 788 or 789 of a Schedule (within the meaning of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018) applies;

if:

(c) the service is an unreferred service; and

(d) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and

(e) the person is not an admitted patient of a hospital; and

(f) the service is not provided in consulting rooms; and

(g) the service is provided in a designated area; and

(h) the service is provided by, or on behalf of, a medical practitioner whose practice location is not in a designated area; and

(i) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item mentioned in paragraph (a) or (b) applying to the service

23.05

 

Part 4Diagnostic procedures and investigations

Division 4.1Group D1: Miscellaneous diagnostic procedures and investigations

4.1.1  Meaning of report

  In this Division:

report means a report prepared by a medical practitioner.

4.1.2  Meaning of qualified adult sleep medicine practitioner, qualified paediatric sleep medicine practitioner and qualified sleep medicine practitioner

 (1) In this Schedule:

qualified adult sleep medicine practitioner means a person who meets the conditions in one of subclauses (2), (3), (4) and (5) relating to:

 (a) the field (the relevant field) of adult sleep medicine; or

 (b) the training program (the relevant training program) of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association known as the Advanced Training Program in Adult Sleep Medicine.

qualified paediatric sleep medicine practitioner means a person who meets the conditions in one of subclauses (2), (3), (4) and (5) relating to:

 (a) the field (the relevant field) of paediatric sleep medicine; or

 (b) the training program (the relevant training program) of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association known as the Advanced Training Program in Paediatric Sleep Medicine.

qualified sleep medicine practitioner means a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner.

RACP Advisory Committee means the Specialist Advisory Committee in Thoracic and Sleep Medicine of the Royal Australasian College of Physicians.

RACP Appeal Committee means the Appeal Committee of the Royal Australasian College of Physicians.

RACP Credentialling Subcommittee means the Credentialling Subcommittee of the RACP Advisory Committee.

Conditions for being a qualified sleep medicine practitioner

 (2) A person meets the conditions in this subclause if the person has been assessed by the RACP Credentialling Subcommittee or the RACP Appeal Committee as having had, before 1 March 1999, sufficient training and experience in the relevant field to be competent in:

 (a) independent clinical assessment and management of patients with respiratory sleep disorders; and

 (b) reporting sleep studies.

 (3) A person meets the conditions in this subclause if:

 (a) the person has been assessed by the RACP Credentialling Subcommittee or the RACP Appeal Committee as having had, before 1 March 1999, substantial training or experience in sleep medicine, but requiring further specified training or experience in the relevant field to be competent in:

 (i) independent clinical assessment and management of patients with respiratory sleep disorders; and

 (ii) reporting sleep studies; and

 (b) either:

 (i) the person has been assessed by the RACP Credentialling Subcommittee as having satisfactorily finished the further specified training or gained the further specified experience; or

 (ii) where an assessment mentioned in paragraph (a) has been carried out, less than 2 years has passed since the assessment.

 (4) A person meets the conditions in this subclause if the person has attained Level I or Level II of the relevant training program after completing at least 12 months core training, including clinical practice in the relevant field and in reporting sleep studies.

 (5) A person meets the conditions in this subclause if the RACP Advisory Committee has recognised the person, in writing, as having training equivalent to the training mentioned in subclause (4).

4.1.3  Restriction on item 11801—service provided in association with other services

  Item 11801 does not apply to a service described in the item if the service is provided in association with a service described in item 11800, 11810, 11820, 11823, 11830 or 11833.

4.1.4  Restrictions on items 12306 to 12322

 (1) Items 12306 to 12322 apply to a service for a patient only as set out in this clause.

 (2) The items apply to a service that is provided by a specialist or consultant physician to whom the patient has been referred by another medical practitioner.

 (3) The items also apply to a service that is provided as follows:

 (a) a person (the radiation licence holder) who holds a radiation licence under a law of a State or Territory performs the service (other than interpretation and reporting) under the supervision of a specialist or consultant physician;

 (b) the specialist or consultant physician performs the interpretation and reporting for the service;

 (c) the radiation licence authorises the radiation licence holder to undertake the activities involved in performing the service (other than interpretation and reporting);

 (d) the patient has been referred to the specialist or consultant physician by another medical practitioner;

 (e) for items 12320 and 12322—if the service is performed using quantitative computed tomography:

 (i) the radiation licence holder is registered as a medical radiation practitioner under a law of a State or Territory; and

 (ii) the specialist or consultant physician is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally.

4.1.5  Items in Group D1

  This clause sets out items in Group D1.

 

Group D1—Miscellaneous diagnostic procedures and investigations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Neurology

11000

Electroencephalography, other than a service:

(a) associated with a service to which item 11003, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices (Anaes.)

126.95

11003

Electroencephalography, prolonged recording lasting at least 3 hours, other than a service:

(a) associated with a service to which item 11000, 11004, 11005, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

335.85

11004

Electroencephalography, ambulatory or video, prolonged recording lasting at least 3 hours and up to 24 hours, recording on the first day, other than a service:

(a) associated with a service to which item 11000, 11003, 11005, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

335.85

11005

Electroencephalography, ambulatory or video, prolonged recording lasting at least 3 hours and up to 24 hours, recording on each day after the first day, other than a service:

(a) associated with a service to which item 11000, 11003, 11004, 11006 or 11009 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

335.85

11006

Electroencephalography, temporosphenoidal, other than a service involving quantitative topographic mapping using neurometrics or similar devices

172.20

11009

Electrocorticography

234.85

11012

Neuromuscular electrodiagnosis—conduction studies on one nerve or electromyography of one or more muscles using concentric needle electrodes or both these examinations (other than a service associated with a service to which item 11015 or 11018 applies)

115.50

11015

Neuromuscular electrodiagnosis—conduction studies on 2 or 3 nerves with or without electromyography (other than a service associated with a service to which item 11012 or 11018 applies)

154.60

11018

Neuromuscular electrodiagnosis—conduction studies on 4 or more nerves with or without electromyography or recordings from single fibres of nerves and muscles or both of these examinations (other than a service associated with a service to which item 11012 or 11015 applies)

230.95

11021

Neuromuscular electrodiagnosis—repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis or both of these examinations

154.60

11024

Central nervous system evoked responses, investigation of, by computerised averaging techniques, other than a service involving quantitative topographic mapping of eventrelated potentials or involving multifocal multichannel objective perimetry—one or 2 studies

117.40

11027

Central nervous system evoked responses, investigation of, by computerised averaging techniques, other than a service involving quantitative topographic mapping of eventrelated potentials or involving multifocal multichannel objective perimetry—3 or more studies

174.15

Subgroup 2—Ophthalmology

11200

Provocative test or tests for open angle glaucoma, including water drinking

42.05

11204

Electroretinography of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards, performed by or on behalf of a specialist or consultant physician in the practice of the specialist’s or consultant physician’s speciality

111.65

11205

Electrooculography of one or both eyes performed according to current professional guidelines or standards, performed by or on behalf of a specialist or consultant physician in the practice of the specialist’s or consultant physician’s speciality

111.65

11210

Pattern electroretinography of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards

111.65

11211

Dark adaptometry of one or both eyes with a quantitative estimation of threshold in log lumens at 45 minutes of dark adaptations

111.65

11215

Retinal angiography, multiple exposures, of one eye with intravenous dye injection

126.80

11218

Retinal angiography, multiple exposures of both eyes with intravenous dye injection

156.70

11220

Optical coherence tomography, to a maximum of one service per eye per lifetime, for the assessment of the need for treatment following provision of pharmaceutical benefits schemesubsidised ocriplasmin

41.25

11221

Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of the specialist’s specialty, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral—to a maximum of 3 examinations (including examinations to which item 11224 applies) in any 12 month period

69.90

11224

Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of the specialist’s specialty, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral—to a maximum of 3 examinations (including examinations to which item 11221 applies) in any 12 month period

42.10

11235

Examination of the eye by impression cytology of cornea for the investigation of ocular surface dysplasia, including the collection of cells, processing and all cytological examinations and preparation of a report

126.55

11237

Ocular contents, simultaneous ultrasonic echography by both unidimensional and bidimensional techniques, for the diagnosis, monitoring or measurement of choroidal and ciliary body melanomas, retinoblastoma or suspicious naevi or simulating lesions, one eye, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

84.00

11240

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of one eye before lens surgery on that eye, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

84.00

11241

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for bilateral eye measurement before lens surgery on both eyes, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

106.90

11242

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of an eye previously measured and on which lens surgery has been performed, and if further lens surgery is contemplated in that eye, other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

82.60

11243

Orbital contents, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of a second eye if:

(a) surgery for the first eye has resulted in more than one dioptre of error; or

(b) more than 3 years have elapsed since the surgery for the first eye;

other than a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

82.60

11244

Orbital contents, diagnostic Bscan of, by a specialist practising in the specialist’s specialty of ophthalmology, not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies

79.40

Subgroup 3—Otolaryngology

11300

Brain stem evoked response audiometry (Anaes.)

198.50

11303

Electrocochleography, extratympanic method, one or both ears

198.50

11304

Electrocochleography, transtympanic membrane insertion technique, one or both ears

326.85

11306

Nondeterminate audiometry

22.60

11309

Audiogram, air conduction

27.10

11312

Audiogram, air and bone conduction or air conduction and speech discrimination

38.30

11315

Audiogram, air and bone conduction and speech

50.75

11318

Audiogram, air and bone conduction and speech, with other cochlear tests

62.65

11324

Impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of the specialist’s specialty, if the patient is referred by a medical practitioner—other than a service associated with a service to which item 11309, 11312, 11315 or 11318 applies

33.90

11327

Impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of the specialist’s specialty, if the patient is referred by a medical practitioner—being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies

20.35

11330

Impedance audiogram if the patient is not referred by a medical practitioner—one examination in any 4 week period

8.15

11332

Otoacoustic emission audiometry for the detection of permanent congenital hearing impairment, performed by or on behalf of a specialist or consultant physician, on an infant or child in circumstances in which:

(a) the patient is referred to a specialist or consultant physician by a medical practitioner; and

(b) the specialist or consultant physician has given an opinion that excludes middle ear pathology for the patient; and

(c) the patient is at risk due to one or more of the following factors:

(i) admission to a neonatal intensive care unit;

(ii) family history of hearing impairment;

(iii) intrauterine or perinatal infection (either suspected or confirmed);

(iv) birthweight less than 1.5 kg;

(v) craniofacial deformity;

(vi) birth asphyxia;

(vii) chromosomal abnormality, including Down Syndrome;

(viii) exchange transfusion

60.40

11333

Caloric test of labyrinth or labyrinths

46.00

11336

Simultaneous bithermal caloric test of labyrinths

46.00

11339

Electronystagmography

46.00

Subgroup 4—Respiratory

11503

Complex measurement of properties of the respiratory system, including the lungs and respiratory muscles, that is performed:

(a) in a respiratory laboratory; and

(b) under the supervision of a consultant respiratory physician who is responsible for staff training, supervision, quality assurance and the issuing of written reports on tests performed; and

(c) using any of the following tests:

(i) measurement of absolute lung volumes by any method;

(ii) measurement of carbon monoxide diffusing capacity by any method;

(iii) measurement of airway or pulmonary resistance by any method;

(iv) inhalation provocation testing, including preprovocation spirometry and the construction of a dose response curve, using a recognised direct or indirect bronchoprovocation agent and postbronchodilator spirometry;

(v) provocation testing involving sequential measurement of lung function at baseline and after exposure to specific sensitising agents, including drugs, or occupational asthma triggers;

(vi) spirometry performed before and after simple exercise testing undertaken as a provocation test for the investigation of asthma, in premises equipped with resuscitation equipment and personnel trained in Advanced Life Support;

(vii) measurement of the strength of inspiratory and expiratory muscles at multiple lung volumes;

(viii) simulated altitude test involving exposure to hypoxic gas mixtures and oxygen saturation at rest and/or during exercise with or without an observation of the effect of supplemental oxygen;

(ix) calculation of pulmonary or cardiac shunt by measurement of arterial oxygen partial pressure and haemoglobin concentration following the breathing of an inspired oxygen concentration of 100% for 15 minutes or greater;

(x) if the measurement is for the purpose of determining eligibility for pulmonary arterial hypertension medications subsidised under the Pharmaceutical Benefits Scheme or eligibility for the provision of portable oxygen—functional exercise test by any method (including 6 minute walk test and shuttle walk test);

each occasion at which one or more tests are performed

Not applicable to a service performed in association with a spirometry or sleep study service to which item 11505, 11506, 11507, 11508, 11512, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Not applicable to a service to which item 11507 applies

142.95

11505

Measurement of spirometry, that:

(a) involves a permanently recorded tracing, performed before and after inhalation of a bronchodilator; and

(b) is performed to confirm diagnosis of:

(i) asthma; or

(ii) chronic obstructive pulmonary disease (COPD); or

(iii) another cause of airflow limitation;

each occasion at which 3 or more recordings are made

Applicable only once in any 12 month period

42.40

11506

Measurement of spirometry, that:

(a) involves a permanently recorded tracing, performed before and after inhalation of a bronchodilator; and

(b) is performed to:

(i) confirm diagnosis of chronic obstructive pulmonary disease (COPD); or

(ii) assess acute exacerbations of asthma; or

(iii) monitor asthma and COPD; or

(iv) assess other causes of obstructive lung disease or the presence of restrictive lung disease;

each occasion at which recordings are made

21.20

11507

Measurement of spirometry:

(a) that includes continuous measurement of the relationship between flow and volume during expiration or during expiration and inspiration, performed before and after inhalation of a bronchodilator; and

(b) fractional exhaled nitric oxide (FeNO) concentration in exhaled breath;

if:

(c) the measurement is performed:

(i) under the supervision of a specialist or consultant physician; and

(ii) with continuous attendance by a respiratory scientist; and

(iii) in a respiratory laboratory equipped to perform complex lung function tests; and

(d) a permanently recorded tracing and written report is provided; and

(e) 3 or more spirometry recordings are performed unless difficult to achieve for clinical reasons;

each occasion at which one or more such tests are performed

Not applicable to a service associated with a service to which item 11503 or 11512 applies

103.35

11508

Maximal symptomlimited incremental exercise test using a calibrated cycle ergometer or treadmill, if:

(a) the test is performed for the evaluation of:

(i) breathlessness of uncertain cause from tests performed at rest; or

(ii) breathlessness out of proportion with impairment due to known conditions; or

(iii) functional status and prognosis in a patient with significant cardiac or pulmonary disease for whom complex procedures such as organ transplantation are considered; or

(iv) anaesthetic and perioperative risks in a patient undergoing major surgery who is assessed as substantially above average risk after standard evaluation; and

(b) the test has been requested by a specialist or consultant physician following professional attendance on the patient by the specialist or consultant physician; and

(c) a respiratory scientist and a medical practitioner are in constant attendance during the test; and

(d) the test is performed in a respiratory laboratory equipped with airway management and defibrillator equipment; and

(e) there is continuous measurement of at least the following:

(i) work rate;

(ii) pulse oximetry;

(iii) respired oxygen and carbon dioxide partial pressures and respired volumes;

(iv) ECG;

(v) heart rate and blood pressure; and

(f) interpretation and preparation of a permanent report is provided by a consultant respiratory physician who is also responsible for the supervision of technical staff and quality assurance

299.90

11512

Measurement of spirometry:

(a) that includes continuous measurement of the relationship between flow and volume during expiration or during expiration and inspiration, performed before and after inhalation of a bronchodilator; and

(b) that is performed with a respiratory scientist in continuous attendance; and

(c) that is performed in a respiratory laboratory equipped to perform complex lung function tests; and

(d) that is performed under the supervision of a consultant physician practising respiratory medicine who is responsible for staff training, supervision, quality assurance and the issuing of written reports; and

(e) for which a permanently recorded tracing and written report is provided; and

(f) for which 3 or more spirometry recordings are performed;

each occasion at which one or more such tests are performed

Not applicable for a service associated with a service to which item 11503 or 11507 applies

63.70

Subgroup 5—Vascular

11600

Central venous, pulmonary arterial, systemic arterial or cardiac intracavity blood pressure monitoring by indwelling catheter—once per day for each type of pressure for a patient, other than a service:

(a) associated with the management of general anaesthesia; and

(b) to which item 13876 applies

71.45

11602

Investigation of venous reflux or obstruction in one or more limbs at rest by CW Doppler or pulsed Doppler involving examination at multiple sites along each limb using intermittent limb compression or Valsalva manoeuvres, or both, to detect prograde and retrograde flow, other than a service associated with a service to which item 32500 applies—hard copy trace and written report, the report component of which must be performed by a medical practitioner, maximum of 2 examinations in a 12 month period, not to be used in conjunction with sclerotherapy

59.55

11604

Investigation of chronic venous disease in the upper and lower extremities, one or more limbs, by plethysmography (excluding photoplethysmography)—examination, hard copy trace and written report, not being a service associated with a service to which item 32500 applies

78.05

11605

Investigation of complex chronic lower limb reflux or obstruction, in one or more limbs, by infrared photoplethysmography, during and following exercise to determine surgical intervention or the conservative management of deep venous thrombotic disease—hard copy trace, calculation of 90% recovery time and written report, not being a service associated with a service to which item 32500 applies

78.05

11610

Measurement of ankle—brachial indices and arterial waveform analysis, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of lower extremity arterial disease—examination, hard copy trace and report

65.70

11611

Measurement of wrist—brachial indices and arterial waveform analysis, measurement of radial and ulnar (or finger) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of the wrist (or finger) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of upper extremity arterial disease—examination, hard copy trace and report

65.70

11612

Exercise study for the evaluation of lower extremity arterial disease, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices for the evaluation of lower extremity arterial disease at rest and following exercise using a treadmill or bicycle ergometer or other such equipment, if the exercise workload is quantifiably documented—examination and report

115.90

11614

Transcranial doppler, examination of the intracranial arterial circulation using CW Doppler or pulsed Doppler with hard copy recording of waveforms, examination and report, other than a service associated with a service to which item 55229 or 55280 of the diagnostic imaging services table applies

78.05

11615

Measurement of digital temperature, one or more digits, (unilateral or bilateral) and report, with hard copy recording of temperature before and for 10 minutes or more after cold stress testing

78.25

11627

Pulmonary artery pressure monitoring during open heart surgery, in a person under 12 years of age

235.80

Subgroup 6—Cardiovascular

11713

Signal averaged ECG recording involving not more than 300 beats, using at least 3 leads with data acquisition at not less than 1000Hz of at least 100 QRS complexes, including analysis, interpretation and report of recording by a specialist physician or consultant physician

71.90

11715

Blood dye—dilution indicator test

124.55

11718

Implanted pacemaker testing involving electrocardiography, measurement of rate, width and amplitude of stimulus, including reprogramming when required, other than a service associated with a service to which item 11719, 11720, 11721, 11725 or 11726 applies

35.85

11719

Implanted pacemaker (including cardiac resynchronisation pacemaker) remote monitoring involving reviews (without patient attendance) of arrhythmias, lead and device parameters, if at least one remote review is provided in a 12 month period

Applicable once in any 12 month period

68.90

11720

Implanted pacemaker testing, with patient attendance, following detection of abnormality by remote monitoring involving electrocardiography, measurement of rate, width and amplitude of stimulus, including reprogramming when required, not being a service associated with a service to which item 11718 or 11721 applies

68.90

11721

Implanted pacemaker testing of atrioventricular (AV) sequential, rate responsive, or antitachycardia pacemakers, including reprogramming when required, other than a service associated with a service to which item 11718, 11719, 11720, 11725 or 11726 applies

71.90

11724

Upright tilt table testing for the investigation of syncope of suspected cardiothoracic origin, including blood pressure monitoring, continuous ECG monitoring and the recording of the parameters, and involving an established intravenous line and the continuous attendance of a specialist or consultant physician—on premises equipped with a mechanical respirator and defibrillator

174.15

11725

Implanted defibrillator (including cardiac resynchronisation defibrillator) remote monitoring involving reviews (without patient attendance) of arrhythmias, lead and device parameters, if at least 2 remote reviews are provided in a 12 month period

Applicable once in any 12 month period

195.45

11726

Implanted defibrillator testing, with patient attendance, following detection of abnormality by remote monitoring involving electrocardiography, measurement of rate, width and amplitude of stimulus, not being a service associated with a service to which item 11727 applies

97.70

11727

Implanted defibrillator testing involving electrocardiography, assessment of pacing and sensing thresholds for pacing and defibrillation electrodes, download and interpretation of stored events and electrograms, including programming when required, other than a service associated with a service to which item 11718, 11719, 11720, 11721, 11725 or 11726 applies

97.70

11728

Implanted loop recording for the investigation of atrial fibrillation if the patient to whom the service is provided has been diagnosed as having had an embolic stroke of undetermined source, including reprogramming when required, retrieval of stored data, analysis, interpretation and report, other than a service to which item 38288 applies

For any particular patient—applicable not more than 4 times in any 12 months

35.85

Subgroup 7—Gastroenterology and colorectal

11800

Oesophageal motility test, manometric

179.90

11801

Clinical assessment of gastrooesophageal reflux disease that involves 48hour catheterfree wireless ambulatory oesophageal pH monitoring, including administration of the device and associated endoscopy procedure for placement, analysis and interpretation of the data and all attendances for providing the service, if:

(a) a catheterbased ambulatory oesophageal pH monitoring:

(i) has been attempted on the patient but failed due to clinical complications; or

(ii) is not clinically appropriate for the patient due to anatomical reasons (nasopharyngeal anatomy) preventing the use of catheterbased pH monitoring; and

(b) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy (Anaes.)

271.20

11810

Clinical assessment of gastrooesophageal reflux disease involving 24hour pH monitoring, including analysis, interpretation and report and including any associated consultation

179.90

11820

Capsule endoscopy to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device (including administration of the capsule, associated endoscopy procedure if required for placement, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

(a) the service is provided to a patient who:

(i) has overt gastrointestinal bleeding; or

(ii) has gastrointestinal bleeding that is recurrent or persistent, and iron deficiency anaemia that is not due to coeliac disease, and, if the patient also has menorrhagia, has had the menorrhagia considered and managed; and

(b) an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the bleeding; and

(c) the service has not been provided to the same patient on more than 2 occasions in the preceding 12 months; and

(d) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

(e) the service is not associated with a service to which item 30680, 30682, 30684 or 30686 applies

1,267.75

11823

Capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with PeutzJeghers Syndrome, using a capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

(a) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

(b) the item is performed only once in any 2 year period; and

(c) the service is not associated with balloon enteroscopy

1,267.75

11830

Diagnosis of abnormalities of the pelvic floor involving anal manometry or measurement of anorectal sensation or measurement of the rectosphincteric reflex

192.65

11833

Diagnosis of abnormalities of the pelvic floor and sphincter muscles involving electromyography or measurement of pudendal and spinal nerve motor latency

257.55

Subgroup 8—Genitourinary physiological investigations

11900

Urine flow study including peak urine flow measurement, other than a service associated with a service to which item 11919 applies

28.40

11903

Cystometrography, other than a service associated with a service to which any of items 11012 to 11027, 11912, 11915, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies

114.60

11906

Urethral pressure profilometry, other than a service associated with a service to which any of items 11012 to 11027, 11909, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies

114.60

11909

Urethral pressure profilometry with simultaneous measurement of urethral sphincter electromyography, other than a service associated with a service to which item 11906, 11915, 11919, 36800 or an item in Group I3 of the diagnostic imaging services table applies

170.30

11912

Cystometrography with simultaneous measurement of rectal pressure, other than a service associated with a service to which any of items 11012 to 11027, 11903, 11915, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies (Anaes.)

170.30

11915

Cystometrography with simultaneous measurement of urethral sphincter electromyography, other than a service associated with a service to which any of items 11012 to 11027, 11903, 11909, 11912, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies (Anaes.)

170.30

11917

Cystometrography in conjunction with ultrasound of one or more components of the urinary tract, with measurement of any one or more of urine flow rate, urethral pressure profile, rectal pressure, urethral sphincter electromyography; including all imaging associated with cystometrography, other than a service associated with a service to which any of items 11012 to 11027, 11900 to 11915, 11919, 11921 and 36800 applies (Anaes.)

441.75

11919

Cystometrography in conjunction with contrast micturating cystourethrography, with measurement of any one or more of urine flow rate, urethral pressure profile, rectal pressure, urethral sphincter electromyography; including all imaging associated with cystometrography, other than a service associated with a service to which any of items 11012 to 11027, 11900 to 11917, 11921 and 36800 applies (Anaes.)

441.75

11921

Bladder washout test for localisation of urinary infection—not including bacterial counts for organisms in specimens

77.40

Subgroup 9—Allergy testing

12000

Skin prick testing for aeroallergens by a specialist or consultant physician in the practice of the specialist or consultant physician’s specialty, including all allergens tested on the same day, not being a service associated with a service to which item 12001, 12002, 12005, 12012, 12017, 12021, 12022 or 12024 applies

40.15

12001

Skin prick testing for aeroallergens, including all allergens tested on the same day, not being a service associated with a service to which item 12000, 12002, 12005, 12012, 12017, 12021, 12022 or 12024 applies

Applicable only once in any 12 month period

40.15

12002

Repeat skin prick testing of a patient for aeroallergens, including all allergens tested on the same day, if:

(a) further testing for aeroallergens is indicated in the same 12 month period to which item 12001 applies to a service for the patient; and

(b) the service is not associated with a service to which item 12000, 12001, 12005, 12012, 12017, 12021, 12022 or 12024 applies

Applicable only once in any 12 month period

40.15

12003

Skin prick testing for food and latex allergens, including all allergens tested on the same day, not being a service associated with a service to which item 12012, 12017, 12021, 12022 or 12024 applies

40.15

12004

Skin testing for medication allergens (antibiotics or nongeneral anaesthetics agents) and venoms (including prick testing and intradermal testing with a number of dilutions), including all allergens tested on the same day, not being a service associated with a service to which item 12012, 12017, 12021, 12022 or 12024 applies

60.70

12005

Skin testing:

(a) performed by or on behalf of a specialist or consultant physician in the practice of the specialist’s or consultant physician’s specialty; and

(b) for agents used in the perioperative period (including prick testing and intradermal testing with a number of dilutions), to investigate anaphylaxis in a patient with a history of prior anaphylactic reaction or cardiovascular collapse associated with the administration of an anaesthetic; and

(c) including all allergens tested on the same day; and

(d) not being a service associated with a service to which item 12000, 12001, 12002, 12003, 12012, 12017, 12021, 12022 or 12024 applies

81.65

12012

Epicutaneous patch testing in the investigation of allergic dermatitis using not more than 25 allergens

21.45

12017

Epicutaneous patch testing in the investigation of allergic dermatitis using more than 25 allergens but not more than 50 allergens

72.45

12021

Epicutaneous patch testing in the investigation of allergic dermatitis, performed by or on behalf of a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty, using more than 50 allergens but not more than 75 allergens

119.10

12022

Epicutaneous patch testing in the investigation of allergic dermatitis, performed by or on behalf of a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty, using more than 75 allergens but not more than 100 allergens

139.85

12024

Epicutaneous patch testing in the investigation of allergic dermatitis, performed by or on behalf of a specialist, or consultant physician, in the practice of the specialist’s or consultant physician’s specialty, using more than 100 allergens

159.30

Subgroup 10—Other diagnostic procedures and investigations

12200

Collection of specimen of sweat by iontophoresis

38.35

12201

Administration, by a specialist or consultant physician in the practice of the specialist’s or consultant physician’s specialty, of thyrotropin alfarch (recombinant human thyroidstimulating hormone), and arranging services to which items 61426 and 66650 apply, for the detection of recurrent welldifferentiated thyroid cancer in a patient if:

(a) the patient has had a total thyroidectomy and one ablative dose of radioactive iodine; and

(b) the patient is maintained on thyroid hormone therapy; and

(c) the patient is at risk of recurrence; and

(d) on at least one previous whole body scan or serum thyroglobulin test when withdrawn from thyroid hormone therapy, the patient did not have evidence of welldifferentiated thyroid cancer; and

(e) either:

(i) withdrawal from thyroid hormone therapy resulted in severe psychiatric disturbances when hypothyroid; or

(ii) withdrawal is medically contraindicated because the patient has:

(A) unstable coronary artery disease; or

(B) hypopituitarism; or

(C) a high risk of relapse or exacerbation of a previous severe psychiatric illness

Applicable once only in a 12 month period

2,467.65

12203

Overnight diagnostic assessment of sleep, for at least 8 hours, for a patient aged 18 years or more, to confirm diagnosis of a sleep disorder, if:

(a) either:

(i) the patient has been referred by a medical practitioner to a qualified adult sleep medicine practitioner or a consultant respiratory physician who has determined that the patient has a high probability for symptomatic, moderate to severe obstructive sleep apnoea based on clinical screening tool results; or

(ii) following professional attendance on the patient (either facetoface or by video conference) by a qualified adult sleep medicine practitioner or a consultant respiratory physician, the qualified adult sleep medicine practitioner or consultant respiratory physician determines that assessment is necessary to confirm the diagnosis of a sleep disorder; and

(b) the overnight diagnostic assessment is performed to investigate:

(i) suspected obstructive sleep apnoea syndrome where the patient is assessed as not suitable for an unattended sleep study; or

(ii) suspected central sleep apnoea syndrome; or

(iii) suspected sleep hypoventilation syndrome; or

(iv) suspected sleeprelated breathing disorders in association with nonrespiratory comorbid conditions including heart failure, significant cardiac arrhythmias, neurological disease, acromegaly or hypothyroidism; or

(v) unexplained hypersomnolence which is not attributed to inadequate sleep hygiene or environmental factors; or

(vi) suspected parasomnia or seizure disorder where clinical diagnosis cannot be established on clinical features alone (including associated atypical features, vigilance behaviours or failure to respond to conventional therapy); or

(vii) suspected sleep related movement disorder, where the diagnosis of restless legs syndrome is not evident on clinical assessment; and

(c) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(d) there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the overnight diagnostic assessment is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11713 or 12250 is provided to the patient

Applicable only once in any 12 month period

606.35

12204

Overnight assessment of positive airway pressure, for at least 8 hours, for a patient aged 18 years or more, if:

(a) the necessity for an intervention sleep study is determined by a qualified adult sleep medicine practitioner or consultant respiratory physician where a diagnosis of a sleeprelated breathing disorder has been made; and

(b) the patient has not undergone positive airway pressure therapy in the previous 6 months; and

(c) following professional attendance on the patient by a qualified adult sleep medicine practitioner or a consultant respiratory physician (either facetoface or by video conference), the qualified adult sleep medicine practitioner or consultant respiratory physician establishes that the sleeprelated breathing disorder is responsible for the patient’s symptoms; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement;

(ix) position; and

(f) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(g) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(h) the overnight assessment is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11713 or 12250 is provided to the patient

Applicable only once in any 12 month period

606.35

12205

Followup study for a patient aged 18 years or more with a sleeprelated breathing disorder, following professional attendance on the patient by a qualified adult sleep medicine practitioner or consultant respiratory physician, if:

(a) any of the following subparagraphs applies:

(i) there has been a recurrence of symptoms not explained by known or identifiable factors such as inadequate usage of treatment, sleep duration or significant recent illness;

(ii) there has been a significant change in weight or changes in comorbid conditions that could affect sleeprelated breathing disorders, and other means of assessing treatment efficacy (including review of data stored by a therapy device used by the patient) are unavailable or have been equivocal;

(iii) the patient has undergone a therapeutic intervention (including, but not limited to, positive airway pressure, upper airway surgery, positional therapy, appropriate oral appliance, weight loss of more than 10% in the previous 6 months or oxygen therapy), and there is either clinical evidence of suboptimal response or uncertainty about control of sleepdisordered breathing; and

(b) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(c) there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(d) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(e) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(f) the followup study is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11713 or 12250 is provided to the patient

Applicable only once in any 12 month period

606.35

12207

Overnight investigation, for a patient aged 18 years or more, for a sleeprelated breathing disorder, following professional attendance by a qualified adult sleep medicine practitioner or a consultant respiratory physician (either facetoface or by video conference), if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified adult sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and assessment of clinically significant alterations in heart rate and limb movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11713 or 12250 is provided to the patient; and

(h) previous studies have demonstrated failure of continuous positive airway pressure or oxygen; and

(i) if the patient has severe respiratory failure—a further investigation is indicated in the same 12 month period to which items 12204 and 12205 apply to a service for the patient, for the adjustment or testing, or both, of the effectiveness of a positive pressure ventilatory support device (other than continuous positive airway pressure) in sleep

Applicable only once in any 12 month period

606.35

12208

Overnight investigation for sleep apnoea for at least 8 hours, for a patient aged 18 years or more, if:

(a) a qualified adult sleep medicine practitioner or consultant respiratory physician has determined that the investigation is necessary to confirm the diagnosis of a sleep disorder; and

(b) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(c) there is continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(d) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(e) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(f) a further investigation is indicated in the same 12 month period to which item 12203 applies to a service for the patient because insufficient sleep was acquired, as evidenced by a sleep efficiency of 25% or less, during the previous investigation to which that item applied; and

(g) the investigation is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11713 or 12250 is provided to the patient

Applicable only once in any 12 month period

606.35

12210

Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient

For each particular patient—applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period

723.80

12213

Overnight paediatric investigation, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient

For each particular patient—applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period

652.05

12215

Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period to which item 12210 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or noninvasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12210 applied for the patient, and further titration of respiratory support is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12210 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support

Applicable only once in the same 12 month period to which item 12210 applies

723.80

12217

Overnight paediatric investigation for at least 8 hours for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period to which item 12213 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or noninvasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12213 applied for the patient, and further titration is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12213 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support

Applicable only once in the same 12 month period to which item 12213 applies

652.05

12250

Overnight investigation of sleep for at least 8 hours of a patient aged 18 years or more to confirm diagnosis of obstructive sleep apnoea, if:

(a) either:

(i) the patient has been referred by a medical practitioner to a qualified adult sleep medicine practitioner or a consultant respiratory physician who has determined that the patient has a high probability for symptomatic, moderate to severe obstructive sleep apnoea based on clinical screening tool results; or

(ii) following professional attendance on the patient (either facetoface or by video conference) by a qualified adult sleep medicine practitioner or a consultant respiratory physician, the qualified adult sleep medicine practitioner or consultant respiratory physician determines that investigation is necessary to confirm the diagnosis of obstructive sleep apnoea; and

(b) during a period of sleep, there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) continuous ECG;

(iv) continuous EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(c) the investigation is performed under the supervision of a qualified adult sleep medicine practitioner; and

(d) either:

(i) the equipment is applied to the patient by a sleep technician; or

(ii) if this is not possible—the reason it is not possible for the sleep technician to apply the equipment to the patient is documented and the patient is given instructions on how to apply the equipment by a sleep technician supported by written instructions; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and cardiac abnormalities) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11713 and 12203 is provided to the patient

Applicable only once in any 12 month period

345.75

12254

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged 18 years or more, if:

(a) a qualified adult sleep medicine practitioner or neurologist determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria under the pharmaceutical benefits scheme for drugs relevant to treat that condition are met; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 nap periods are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12203, 12204, 12205, 12208, 12250 or 12258 is provided to the patient

Applicable only once in a 12 month period

942.20

12258

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged 18 years or more, if:

(a) a qualified adult sleep medicine practitioner or neurologist determines that testing is necessary to objectively confirm the ability to maintain wakefulness; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12203, 12204, 12205, 12208, 12250 or 12254 is provided to the patient

Applicable only once in a 12 month period

942.20

12261

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged at least 12 years but less than 18 years, if:

(a) a qualified sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria under the pharmaceutical benefits scheme for drugs relevant to treat that condition are met; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 nap periods are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12213, 12217 or 12265 is provided to the patient

Applicable only once in a 12 month period

987.95

12265

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged at least 12 years but less than 18 years, if:

(a) a qualified sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12213, 12217 or 12261 is provided to the patient

Applicable only once in a 12 month period

987.95

12268

Multiple sleep latency test for the assessment of unexplained hypersomnolence for a patient less than 12 years of age, if:

(a) a qualified paediatric sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria under the pharmaceutical benefits scheme for drugs relevant to treat that condition are met; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 nap periods are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified paediatric sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12210, 12215 or 12272 is provided to the patient

Applicable only once in a 12 month period

1,059.65

12272

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness for a patient less than 12 years of age, if:

(a) a qualified paediatric sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multichannel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either endtidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified paediatric sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12210, 12215 or 12268 is provided to the patient

Applicable only once in a 12 month period

1,059.65

12306

Bone densitometry, using dual energy Xray absorptiometry, involving the measurement of 2 or more sites (including interpretation and reporting), for:

(a) confirmation of a presumptive diagnosis of low bone mineral density made on the basis of one or more fractures occurring after minimal trauma; or

(b) monitoring of low bone mineral density proven by bone densitometry at least 12 months previously;

other than a service associated with a service to which item 12312, 12315 or 12321 applies

For any particular patient, once only in a 24 month period

105.60

12312

Bone densitometry, using dual energy Xray absorptiometry, involving the measurement of 2 or more sites (including interpretation and reporting) for diagnosis and monitoring of bone loss associated with one or more of the following:

(a) prolonged glucocorticoid therapy;

(b) any condition associated with excess glucocorticoid secretion;

(c) male hypogonadism;

(d) female hypogonadism lasting more than 6 months before the age of 45;

other than a service associated with a service to which item 12306, 12315 or 12321 applies

For any particular patient, once only in a 12 month period

105.60

12315

Bone densitometry, using dual energy Xray absorptiometry, involving the measurement of 2 or more sites (including interpretation and reporting) for diagnosis and monitoring of bone loss associated with one or more of the following conditions:

(a) primary hyperparathyroidism;

(b) chronic liver disease;

(c) chronic renal disease;

(d) any proven malabsorptive disorder;

(e) rheumatoid arthritis;

(f) any condition associated with thyroxine excess;

other than a service associated with a service to which item 12306, 12312 or 12321 applies

For any particular patient, once only in a 24 month period

105.60

12320

Bone densitometry, using dual energy Xray absorptiometry or quantitative computed tomography, involving the measurement of 2 or more sites (including interpretation and reporting) for the measurement of bone mineral density, if:

(a) the patient is 70 years of age or over; and

(b) either:

(i) the patient has not previously had bone densitometry; or

(ii) the tscore for the patient’s bone mineral density is 1.5 or more;

other than a service associated with a service to which item 12306, 12312, 12315, 12321 or 12322 applies

For any particular patient, once only in a 5 year period

105.60

12321

Bone densitometry, using dual energy Xray absorptiometry, involving the measurement of 2 or more sites at least 12 months after a significant change in therapy (including interpretation and reporting), for:

(a) established low bone mineral density; or

(b) confirming a presumptive diagnosis of low bone mineral density made on the basis of one or more fractures occurring after minimal trauma;

other than a service associated with a service to which item 12306, 12312 or 12315 applies

For any particular patient, once only in a 12 month period

105.60

12322

Bone densitometry, using dual energy Xray absorptiometry or quantitative computed tomography, involving the measurement of 2 or more sites (including interpretation and reporting) for measurement of bone mineral density, if:

(a) the patient is 70 years of age or over; and

(b) the tscore for the patient’s bone mineral density is less than 1.5 but more than 2.5;

other than a service associated with a service to which item 12306, 12312, 12315, 12320 or 12321 applies

For any particular patient, once only in a 2 year period

105.60

12325

Assessment of visual acuity and bilateral retinal photography with a nonmydriatic retinal camera, including analysis and reporting of the images for initial or repeat assessment for presence or absence of diabetic retinopathy, in a patient with medically diagnosed diabetes, if:

(a) the patient is of Aboriginal and Torres Strait Islander descent; and

(b) the assessment is performed by the medical practitioner (other than an optometrist or ophthalmologist) providing the primary glycaemic management of the patient’s diabetes; and

(c) this item and item 12326 have not applied to the patient in the preceding 12 months; and

(d) the patient does not have:

(i) an existing diagnosis of diabetic retinopathy; or

(ii) visual acuity of less than 6/12 in either eye; or

(iii) a difference of more than 2 lines of vision between the 2 eyes at the time of presentation

51.55

12326

Assessment of visual acuity and bilateral retinal photography with a nonmydriatic retinal camera, including analysis and reporting of the images for initial or repeat assessment for presence or absence of diabetic retinopathy, in a patient with medically diagnosed diabetes, if:

(a) the assessment is performed by the medical practitioner (other than an optometrist or ophthalmologist) providing the primary glycaemic management of the patient’s diabetes; and

(b) this item and item 12325 have not applied to the patient in the preceding 24 months; and

(c) the patient does not have:

(i) an existing diagnosis of diabetic retinopathy; or

(ii) visual acuity of less than 6/12 in either eye; or

(iii) a difference of more than 2 lines of vision between the 2 eyes at the time of presentation

51.55

 

Division 4.2Group D2: Nuclear medicine (nonimaging)

4.2.1  Restriction on items in Group D2—services connected with services in item 12250

  An item in Group D2 does not apply to a service described in the item if the service is provided at the same time as, or in connection with, the service described in item 12250.

4.2.2  Items in Group D2

  This clause sets out items in Group D2.

 

Group D2—Nuclear medicine (nonimaging)

Column 1

Item

Column 2

Description

Column 3

Fee ($)

12500

Blood volume estimation

223.40

12524

Renal function test (without imaging procedure)

163.30

12527

Renal function test (with imaging and at least 2 blood samples)

87.60

12533

Carbonlabelled urea breath test using oral C13 or C14 urea, performed by a specialist or consultant physician, including the measurement of exhaled 13CO2 or 14CO2, for either:

(a) the confirmation of Helicobacter pylori colonisation; or

(b) the monitoring of the success of eradication of Helicobacter pylori in patients with peptic ulcer disease;

(other than a service associated with a service to which item 66900 applies)

87.30

 

Part 5Therapeutic procedures

Division 5.1Preliminary

5.1.1  Restriction on items in this Part—services connected with provision of pain pump for postsurgical pain management

  An item in Group T1, T2, T3, T4, T6, T7, T8, T9 or T10 does not apply to a service described in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for postsurgical pain management.

Division 5.2Group T1: Miscellaneous therapeutic procedures

5.2.1  Meaning of comprehensive hyperbaric medicine facility

  In items 13015, 13020, 13025 and 13030:

comprehensive hyperbaric medicine facility means a separate hospital area that, on a 24hour basis:

 (a) is equipped and staffed so that it is capable of providing to a patient:

 (i) hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and

 (ii) mechanical ventilation and invasive cardiovascular monitoring within a monoplace or multiplace chamber for the duration of the hyperbaric treatment; and

 (b) is under the direction of at least one medical practitioner who is rostered, and immediately available, to the facility during the facility’s ordinary working hours if the practitioner:

 (i) is a specialist with training in diving and hyperbaric medicine; or

 (ii) holds a Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society; and

 (c) is staffed by:

 (i) at least one medical practitioner with training in diving and hyperbaric medicine who is present in the facility and immediately available at all times when patients are being treated at the facility; and

 (ii) at least one registered nurse with specific training in hyperbaric patient care to the published standards of the Hyperbaric Technicians and Nurses Association, who is present during hyperbaric oxygen therapy; and

 (d) has admission and discharge policies in operation.

5.2.2  Meaning of embryology laboratory services

  In items 13200, 13201 and 13206:

embryology laboratory services includes:

 (a) egg recovery from aspirated follicular fluid; and

 (b) semen preparation; and

 (c) insemination; and

 (d) monitoring of fertilisation and embryo development; and

 (e) preparation of gametes or embryos for transfer or freezing.

5.2.3  Meaning of treatment cycle

  In clause 5.2.4 and items 13200 to 13209, 13215 and 13218:

treatment cycle, for a patient, means a series of treatments for the patient that:

 (a) begins:

 (i) if treatment with superovulatory drugs is given—on the day on which that treatment begins; or

 (ii) if treatment with superovulatory drugs is not given—on the first day of a menstrual cycle of the patient; and

 (b) ends:

 (i) if a service described in item 13212, 13215 or 13221 is provided in connection with the series of treatments—on the day after the day on which the last of those services is provided; or

 (ii) in any other case—not more than 30 days after the day mentioned in subparagraph (a)(i) or (ii).

5.2.4  Items provided as part of treatment cycle relating to assisted reproductive services not to apply

 (1) This clause applies if:

 (a) a service to which an item (the first item) in Subgroup 3 of Group T1 applies is provided to a patient during a treatment cycle; and

 (b) a service described in an item (the second item) (other than an item in Subgroup 3 of Group T1) is provided to the patient during the same treatment cycle; and

 (c) the service described in the second item is associated with the service to which the first item applies.

 (2) The second item does not apply to the service described in that item.

5.2.5  Restriction on item 13104—timing

  Item 13104 does not apply to a patient more than 12 times in a 12 month period.

5.2.6  Restriction on items relating to assisted reproductive services—certain pregnancyrelated circumstances

  Items 13200 to 13221 do not apply to a service provided in relation to a patient’s pregnancy, or intended pregnancy, that is, at the time of the service, the subject of an agreement, or arrangement, under which the patient makes provision for transfer to another person of the guardianship of, or custodial rights to, a child born as a result of the pregnancy.

5.2.7  Restrictions on items 14227 to 14242—patients

  Items 14227 to 14242 apply to a service in relation to a patient only if:

 (a) the patient has:

 (i) chronic spasticity of cerebral origin; or

 (ii) chronic spasticity caused by multiple sclerosis, spinal cord injury or spinal cord disease; and

 (b) oral antispastic agents have failed or have caused the patient to experience unacceptable side effects; and

 (c) an authority has been given by the Chief Executive Medicare to provide the service to the patient.

5.2.8  Restrictions on item 14245—practitioner and timing

 (1) Item 14245 applies only to a service provided by a medical practitioner who is registered by the Chief Executive Medicare to participate in the arrangements made, under paragraph 100(1)(b) of the National Health Act 1953, for providing an adequate pharmaceutical service for persons requiring treatment with an immunomodulating agent.

 (2) Item 14245 applies once per day.

5.2.9  Restriction on item 13899—other services performed on the same day

  Item 13899 does not apply to professional attendance by a specialist on a day for preparation of goals of care for a patient if, on that day, the specialist performs a service for the patient that is described in item 13870 or 13873.

5.2.10  Items in Group T1

  This clause sets out items in Group T1.

 

Group T1—Miscellaneous therapeutic procedures

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Hyperbaric oxygen therapy

13015

Hyperbaric oxygen therapy, for treatment of localised nonneurological soft tissue radiation injuries excluding radiationinduced soft tissue lymphoedema of the arm after treatment for breast cancer, performed in a comprehensive hyperbaric medicine facility under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber of at least 1 hour 30 minutes and not more than 3 hours, including any associated attendance

262.75

13020

Hyperbaric oxygen therapy, for treatment of decompression illness, gas gangrene, air or gas embolism, diabetic wounds (including diabetic gangrene and diabetic foot ulcers) or necrotising soft tissue infections (including necrotising fasciitis or Fournier’s gangrene), or for the prevention and treatment of osteoradionecrosis, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber of at least 1 hour 30 minutes and not more than 3 hours, including any associated attendance

266.95

13025

Hyperbaric oxygen therapy, for treatment of decompression illness, air or gas embolism, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber greater than 3 hours, including any associated attendance—per hour (or part of an hour)

119.30

13030

Hyperbaric oxygen therapy performed in a comprehensive hyperbaric medicine facility, if the medical practitioner is pressurised in the hyperbaric chamber for the purpose of providing continuous lifesaving emergency treatment, including any associated attendance—per hour (or part of an hour)

168.55

Subgroup 2—Dialysis

13100

Supervision in hospital by a medical specialist of—haemodialysis, haemofiltration, haemoperfusion or peritoneal dialysis, including all professional attendances, if the total attendance time on the patient by the supervising medical specialist exceeds 45 minutes in one day

140.95

13103

Supervision in hospital by a medical specialist of—haemodialysis, haemofiltration, haemoperfusion or peritoneal dialysis, including all professional attendances, if the total attendance time on the patient by the supervising medical specialist does not exceed 45 minutes in one day

73.45

13104

Planning and management of home dialysis (haemodialysis or peritoneal dialysis) for a patient with endstage renal disease and supervision of the patient on selfadministered dialysis, if the attendance is by a consultant physician in the practice of the consultant physician’s specialty of renal medicine

152.55

13105

Haemodialysis for a patient with endstage renal disease if:

(a) the service is provided by a registered nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner; and

(b) the service is supervised by the medical practitioner (either in person or remotely); and

(c) the patient’s care is managed by a nephrologist; and

(d) the patient is treated or reviewed by the nephrologist every 3 to 6 months (either in person or remotely); and

(e) the patient is not an admitted patient of a hospital; and

(f) the service is provided in a Modified Monash 7 area

610.45

13106

Declotting of an arteriovenous shunt

125.15

13109

Indwelling peritoneal catheter (Tenckhoff or similar) for dialysis—insertion and fixation of (Anaes.)

234.85

13110

Indwelling peritoneal catheter (Tenckhoff or similar) for dialysis—removal of (including catheter cuffs) (Anaes.)

235.65

Subgroup 3—Assisted reproductive services

13200

Assisted reproductive technologies superovulated treatment cycle proceeding to oocyte retrieval, involving the use of drugs to induce superovulation and including quantitative estimation of hormones, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination, transfer of frozen embryos or donated embryos or ova or a service to which item 13201, 13202, 13203, 13206 or 13218 applies, being services rendered during one treatment cycle—initial cycle in a single calendar year

3,207.90

13201

Assisted reproductive technologies superovulated treatment cycle proceeding to oocyte retrieval, involving the use of drugs to induce superovulation and including quantitative estimation of hormones, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination, transfer of frozen embryos or donated embryos or ova or a service to which item 13200, 13202, 13203, 13206 or 13218 applies, being services rendered during one treatment cycle—each cycle after the first in a single calendar year

3,000.65

13202

Assisted reproductive technologies superovulated treatment cycle that is cancelled before oocyte retrieval, involving the use of drugs to induce superovulation and including quantitative estimation of hormones and ultrasound examinations, but excluding artificial insemination, transfer of frozen embryos or donated embryos or ova or a service to which item 13200, 13201, 13203, 13206 or 13218 applies, being services rendered during one treatment cycle

480.10

13203

Ovulation monitoring services for artificial insemination, including quantitative estimation of hormones and ultrasound examinations, being services rendered during one treatment cycle but excluding a service to which item 13200, 13201, 13202, 13206, 13212, 13215 or 13218 applies

501.95

13206

Assisted reproductive technologies treatment cycle using the natural cycle or oral medication only to induce oocyte growth and development, including quantitative estimation of hormones, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination, frozen embryo transfer, donated embryos or ova or treatment involving the use of injectable drugs to induce superovulation, being services rendered during one treatment cycle—only if rendered in conjunction with a service to which item 13212 applies

480.10

13209

Planning and management of a referred patient by a specialist for the purpose of treatment by assisted reproductive technologies or for artificial insemination—applicable once during a treatment cycle

87.35

13210

Professional attendance on a patient by a specialist practising in the specialist’s specialty if:

(a) the attendance is by video conference; and

(b) item 13209 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 13209

13212

Oocyte retrieval for the purpose of assisted reproductive technologies—only if rendered in connection with a service to which item 13200, 13201 or 13206 applies (Anaes.)

365.50

13215

Transfer of embryos or both ova and sperm to the uterus or fallopian tubes, excluding artificial insemination—only if rendered in connection with a service to which item 13200, 13201, 13206 or 13218 applies, being services rendered in one treatment cycle (Anaes.)

114.60

13218

Preparation of frozen or donated embryos or donated oocytes for transfer to the uterus or fallopian tubes, by any means and including quantitative estimation of hormones and all treatment counselling but excluding artificial insemination services rendered in one treatment cycle and excluding a service to which item 13200, 13201, 13202, 13203, 13206 or 13212 applies (Anaes.)

818.35

13221

Preparation of semen for the purpose of artificial insemination—only if rendered in connection with a service to which item 13203 applies

52.35

13251

Intracytoplasmic sperm injection for the purpose of assisted reproductive technologies, for male factor infertility, excluding a service to which item 13203 or 13218 applies

431.00

13260

Processing and initial cryopreservation (not including storage) of semen for fertility preservation treatment before or after completion of gonadotoxic treatment for malignant or nonmalignant conditions, in a postpubertal male in Tanner stages II–V, up to 60 years old, who is referred by a specialist or consultant physician—applicable to not more than 2 semen collection cycles

427.95

13290

Semen, collection of, from a patient with spinal injuries or medically induced impotence, for the purposes of analysis, storage or assisted reproduction, by a medical practitioner using a vibrator or electroejaculation device including catheterisation and drainage of bladder if required

210.60

13292

Semen, collection of, from a patient with spinal injuries or medically induced impotence, for the purposes of analysis, storage or assisted reproduction, by a medical practitioner using a vibrator or electroejaculation device including catheterisation and drainage of bladder if required, under general anaesthetic (H) (Anaes.)

421.50

Subgroup 4—Paediatric and neonatal

13300

Umbilical or scalp vein catheterisation in a neonate with or without infusion or cannulation of a vein

58.70

13303

Umbilical artery catheterisation with or without infusion

87.05

13306

Blood transfusion with venesection and complete replacement of blood, including collection from donor

344.55

13309

Blood transfusion with venesection and complete replacement of blood, using blood already collected

293.75

13312

Blood for pathology test, collection of, by femoral or external jugular vein puncture in infants

29.35

13318

Central vein catheterisation by open exposure, in a person under 12 years of age (Anaes.)

234.55

13319

Central vein catheterisation in a neonate via peripheral vein (Anaes.)

234.55

Subgroup 5—Cardiovascular

13400

Restoration of cardiac rhythm by electrical stimulation (cardioversion), other than in the course of cardiac surgery (Anaes.)

99.85

Subgroup 6—Gastroenterology

13506

Gastrooesophageal balloon intubation for control of bleeding from gastric oesophageal varices

190.25

Subgroup 8—Haematology

13700

Harvesting of homologous (including allogeneic) or autologous bone marrow for the purpose of transplantation (Anaes.)

343.70

13703

Transfusion of blood including collection from donor

123.20

13706

Transfusion of blood or bone marrow already collected

85.95

13709

Collection of blood for autologous transfusion or when homologous blood is required for immediate transfusion in emergency situation

50.00

13750

Therapeutic haemapheresis for the removal of plasma or cellular (or both) elements of blood, utilising continuous or intermittent flow techniques, including morphological tests for cell counts and viability studies, if performed; continuous monitoring of vital signs, fluid balance, blood volume and other parameters with continuous registered nurse attendance under the supervision of a consultant physician, other than a service associated with a service to which item 13755 applies—each day

140.95

13755

Donor haemapheresis for the collection of blood products for transfusion, utilising continuous or intermittent flow techniques, including morphological tests for cell counts and viability studies; continuous monitoring of vital signs, fluid balance, blood volume and other parameters; with continuous registered nurse attendance under the supervision of a consultant physician—other than a service associated with a service to which item 13750 applies—each day

140.95

13757

Therapeutic venesection for the management of haemochromatosis, polycythemia vera or porphyria cutanea tarda

75.20

13760

In vitro processing (and cryopreservation) of bone marrow or peripheral blood for autologous stem cell transplantation as an adjunct to high dose chemotherapy for:

(a) chemosensitive intermediate or high grade nonHodgkin lymphoma at high risk of relapse following first line chemotherapy; or

(b) Hodgkin disease which has relapsed following, or is refractory to, chemotherapy; or

(c) acute myelogenous leukaemia in first remission, if suitable genotypically matched sibling donor is not available for allogenic bone marrow transplant; or

(d) multiple myeloma in remission (complete or partial) following standard dose chemotherapy; or

(e) small round cell sarcomas; or

(f) primitive neuroectodermal tumour; or

(g) germ cell tumours which have relapsed following, or are refractory to, chemotherapy; or

(h) germ cell tumours which have had an incomplete response to first line therapy;

performed under the supervision of a consultant physician—each day

786.40

Subgroup 9—Procedures associated with intensive care and cardiopulmonary support

13815

Central vein catheterisation, including under ultrasound guidance where clinically appropriate, by percutaneous or open exposure, other than a service to which item 13318 applies (Anaes.)

117.20

13818

Right heart balloon catheter, insertion of, including pulmonary wedge pressure and cardiac output measurement (Anaes.)

117.25

13830

Intracranial pressure, monitoring of, by intraventricular or subdural catheter, subarachnoid bolt or similar, by a specialist or consultant physician—each day

77.70

13832

Peripheral cannulation, including under ultrasound guidance where clinically appropriate, for venoarterial cardiopulmonary extracorporeal life support

909.30

13834

Veno–arterial cardiopulmonary extracorporeal life support, management of—the first day

509.05

13835

Veno–arterial cardiopulmonary extracorporeal life support, management of—each day after the first

118.45

13837

Venovenous pulmonary extracorporeal life support, management of—the first day

509.05

13838

Venovenous pulmonary extracorporeal life support, management of—each day after the first

118.45

13839

Arterial puncture and collection of blood for diagnostic purposes

23.75

13840

Peripheral cannulation, including under ultrasound guidance where clinically appropriate, for venovenous pulmonary extracorporeal life support

609.20

13842

Intraarterial cannulation, including under ultrasound guidance where clinically appropriate, for the purpose of intraarterial pressure monitoring or arterial blood sampling (or both)

96.50

13848

Counterpulsation by intraaortic balloonmanagement, including associated consultations and monitoring of parameters by means of full haemodynamic assessment and management on several occasions on a day—each day

161.00

13851

Ventricular assist device, management of, for a patient admitted to an intensive care unit for implantation of the device or for complications arising from implantation or management of the device—first day

509.05

13854

Ventricular assist device, management of, for a patient admitted to an intensive care unit, including management of complications arising from implantation or management of the device—each day after the first day

118.45

13857

Airway access and initiation of mechanical ventilation (other than initiation of ventilation in the context of an anaesthetic for surgery), outside of an intensive care unit, for the purpose of subsequent ventilatory support in an intensive care unit

151.00

Subgroup 10—Management and procedures undertaken in an intensive care unit

13870

Management of a patient in an intensive care unit by a specialist or consultant physician who is immediately available and exclusively rostered to intensive care, including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling, bladder catheterisation and blood sampling—management on the first day (H)

373.40

13873

Management of a patient in an intensive care unit by a specialist or consultant physician who is immediately available and exclusively rostered to intensive care, including all attendances, electrocardiographic monitoring, arterial sampling, bladder catheterisation and blood sampling—management on each day after the first day (H)

277.00

13876

Central venous pressure, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure—once per day for each type of pressure for a patient:

(a) when managed for the patient by a specialist or consultant physician who:

(i) is immediately available to care for the patient; and

(ii) is exclusively rostered to intensive care; and

(b) when the patient is continuously monitored by indwelling catheter in an intensive care unit (H)

79.30

13881

Airway access and initiation of mechanical ventilation in an intensive care unit by a specialist or consultant physician to enable subsequent ventilatory support—not in association with any anaesthetic service (H)

151.00

13882

Ventilatory support in an intensive care unit, management of a patient:

(a) by:

(i) invasive means; or

(ii) noninvasive means, if the only alternative to noninvasive ventilatory support is invasive ventilatory support; and

(b) by a specialist or consultant physician who is immediately available and exclusively rostered to intensive care;

each day (H)

118.85

13885

Continuous arterio venous or veno venous haemofiltration, management by a specialist or consultant physician who is immediately available and exclusively rostered to intensive care—on the first day (H)

158.45

13888

Continuous arterio venous or veno venous haemofiltration, management by a specialist or consultant physician who is immediately available and exclusively rostered to intensive care—on each day after the first day (H)

79.30

Subgroup 10A—Preparation of goals of care by intensive care specialist outside intensive care unit

13899

Professional attendance outside an intensive care unit for at least 60 minutes spent in preparation of goals of care for a gravely ill patient lacking current goals of care, by a specialist in the specialty of intensive care who takes overall responsibility for the preparation of the goals of care for the patient

276.25

Subgroup 11—Chemotherapeutic procedures

13915

Cytotoxic chemotherapy, administration of, either by intravenous push technique (directly into a vein, or a butterfly needle, or the sidearm of an infusion) or by intravenous infusion lasting not more than 1 hour, other than a service associated with photodynamic therapy with verteporfin or a service to administer drugs used immediately before, or during, microwave (UHF radiowave) cancer therapy—for any particular patient, once only on the same day

67.10

13918

Cytotoxic chemotherapy, administration of, by intravenous infusion lasting more than 1 hour, but not more than 6 hours—for any particular patient, once only on the same day

101.00

13921

Cytotoxic chemotherapy, administration of, by intravenous infusion lasting more than 6 hours—for the first day of treatment

114.25

13924

Cytotoxic chemotherapy, administration of, by intravenous infusion lasting more than 6 hours—on each day after the first in the same continuous treatment episode

67.30

13927

Cytotoxic chemotherapy, administration of, either by intraarterial push technique (directly into an artery, a butterfly needle or the sidearm of an infusion) or by intraarterial infusion lasting not more than 1 hour—for any particular patient, once only on the same day

87.05

13930

Cytotoxic chemotherapy, administration of, by intraarterial infusion lasting more than 1 hour, but not more than 6 hours—for any particular patient, once only on the same day

121.50

13933

Cytotoxic chemotherapy, administration of, by intraarterial infusion lasting more than 6 hours—for the first day of treatment

134.80

13936

Cytotoxic chemotherapy, administration of, by intraarterial infusion lasting more than 6 hours—on each day after the first in the same continuous treatment episode

87.80

13939

Implanted pump or reservoir, loading of, with a cytotoxic agent or agents, other than a service associated with a service to which item 13915, 13918, 13921, 13924, 13927, 13930, 13933, 13936 or 13945 applies

101.00

13942

Ambulatory drug delivery device, loading of, with a cytotoxic agent or agents for the infusion of the agent or agents via the intravenous, intraarterial or spinal routes, other than a service associated with a service to which item 13915, 13918, 13921, 13924, 13927, 13930, 13933, 13936 or 13945 applies

67.30

13945

Longterm implanted drug delivery device for cytotoxic chemotherapy, accessing of

54.15

13948

Cytotoxic agent, instillation of, into a body cavity

67.30

Subgroup 12—Dermatology

14050

UVA or UVB phototherapy administered in a whole body cabinet or hand and foot cabinet including associated consultations other than the initial consultation, if treatment is initiated and supervised by a specialist in the specialty of dermatology

Applicable not more than 150 times in a 12 month period

54.40

14100

Laser photocoagulation using laser radiation in the treatment of vascular abnormalities of the head or neck, including any associated consultation, if:

(a) the abnormality is visible from 3 metres; and

(b) photographic evidence demonstrating the need for this service is documented in the patient notes;

to a maximum of 4 sessions (including any sessions to which this item or any of items 14106 to 14118 apply) in any 12 month period (Anaes.)

157.25

14106

Laser photocoagulation using laser radiation in the treatment of vascular malformations, infantile haemangiomas, caféaulait macules and naevi of Ota, other than melanocytic naevi (common moles), if the abnormality is visible from 3 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which this item or any of items 14100 to 14118 apply) in any 12 month period—area of treatment less than 150 cm2 (Anaes.)

165.15

14115

Laser photocoagulation using laser radiation in the treatment of vascular malformations, infantile haemangiomas, caféaulait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which this item or any of items 14100 to 14118 apply) in any 12 month period—area of treatment 150 cm2 to 300 cm2 (Anaes.)

264.50

14118

Laser photocoagulation using laser radiation in the treatment of vascular malformations, infantile haemangiomas, caféaulait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which this item or any of items 14100 to 14115 apply) in any 12 month period—area of treatment more than 300 cm2 (Anaes.)

335.90

14124

Laser photocoagulation using laser radiation in the treatment of vascular malformations, infantile haemangiomas, caféaulait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, if:

(a) a seventh or subsequent session (including any sessions to which this item or any of items 14100 to 14118 apply) is indicated in a 12 month period commencing on the day of the first session; and

(b) photographic evidence demonstrating the need for this service is documented in the patient notes

(Anaes.)

157.25

Subgroup 13—Miscellaneous therapeutic procedures

14201

PolyLlactic acid, one or more injections of, for the initial session only, for the treatment of severe facial lipoatrophy caused by antiretroviral therapy, if prescribed in accordance with section 85 of the National Health Act 1953—once per patient

244.25

14202

PolyLlactic acid, one or more injections of (subsequent sessions), for the continuation of treatment of severe facial lipoatrophy caused by antiretroviral therapy, if prescribed in accordance with section 85 of the National Health Act 1953

123.65

14203

Hormone or living tissue implantation, by direct implantation involving incision and suture (Anaes.)

52.75

14206

Hormone or living tissue implantation—by cannula

36.70

14209

Intraarterial infusion or retrograde intravenous perfusion of a sympatholytic agent

91.45

14212

Intussusception, management of fluid or gas reduction for (Anaes.)

191.05

14218

Implanted infusion pump, refilling of reservoir with a therapeutic agent or agents for infusion to the subarachnoid or epidural space, with or without reprogramming a programmable pump, for the management of chronic intractable pain

101.00

14221

Long—term implanted device for delivery of therapeutic agents, accessing of, other than a service associated with a service to which item 13945 applies

54.15

14224

Electroconvulsive therapy, with or without the use of stimulus dosing techniques, including any electroencephalographic monitoring and associated consultation (Anaes.)

72.55

14227

Implanted infusion pump, refilling of reservoir with baclofen for infusion to the subarachnoid or epidural space, with or without reprogramming a programmable pump, for the management of severe chronic spasticity

101.00

14230

Intrathecal or epidural spinal catheter, insertion or replacement of, and connection to a subcutaneous implanted infusion pump, for the management of severe chronic spasticity with baclofen (H) (Anaes.) (Assist.)

307.35

14233

Infusion pump, subcutaneous implantation or replacement of, and:

(a) connection to an intrathecal or epidural spinal catheter; and

(b) filling of reservoir with baclofen;

with or without programming the pump, for the management of severe chronic spasticity (H) (Anaes.) (Assist.)

373.20

14236

All of the following:

(a) infusion pump, subcutaneous implantation of;

(b) intrathecal or epidural spinal catheter, insertion of;

(c) connection of pump to catheter;

(d) filling of reservoir with baclofen;

with or without programming the pump, for the management of severe chronic spasticity (H) (Anaes.) (Assist.)

680.55

14239

Either:

(a) subcutaneously implanted infusion pump, removal of; or

(b) intrathecal or epidural spinal catheter, removal or repositioning of;

for the management of severe chronic spasticity (H) (Anaes.)

164.40

14242

Subcutaneous reservoir and spinal catheter, insertion of, for the management of severe chronic spasticity (H) (Anaes.)

488.45

14245

Immunomodulating agent, administration of, by intravenous infusion lasting at least 2 hours

 

101.00

Subgroup 14—Management and procedures undertaken in emergency department

14255

Resuscitation of a patient provided for at least 30 minutes but less than 1 hour, by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

153.00

14256

Resuscitation of a patient provided for at least 1 hour but less than 2 hours, by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

294.25

14257

Resuscitation of a patient provided for at least 2 hours, by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

586.00

14258

Resuscitation of a patient provided for at least 30 minutes but less than 1 hour, by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

114.80

14259

Resuscitation of a patient provided for at least 1 hour but less than 2 hours, by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

220.70

14260

Resuscitation of a patient provided for at least 2 hours, by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

439.50

14263

Minor procedure on a patient by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

53.85

14264

Procedure (except a minor procedure) on a patient by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

121.25

14265

Minor procedure on a patient by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

40.40

14266

Procedure (except a minor procedure) on a patient by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

90.95

14270

Management, without aftercare, of all fractures and dislocations suffered by a patient that:

(a) is provided by a specialist in the practice of the specialist’s specialty of emergency medicine in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019; and

(b) occurs at a recognised emergency department of a private hospital

(Anaes.)

135.95

14272

Management, without aftercare, of all fractures and dislocations suffered by a patient that:

(a) is provided by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(b) occurs at a recognised emergency department of a private hospital

(Anaes.)

102.00

14277

Application of chemical or physical restraint of a patient by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital

153.00

14278

Application of chemical or physical restraint of a patient by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital

114.80

14280

Anaesthesia (whether general anaesthesia or not) of a patient that:

(a) is managed by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

153.00

14283

Anaesthesia (whether general anaesthesia or not) of a patient that:

(a) is managed by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

114.80

14285

Emergent intubation, airway management or both of a patient that:

(a) is managed by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

153.00

14288

Emergent intubation, airway management or both of a patient that:

(a) is managed by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

114.80

 

Division 5.3Group T2: Radiation oncology

5.3.1  Meaning of amount under clause 5.3.1

  In an item of this Schedule mentioned in column 1 of table 5.3.1:

amount under clause 5.3.1 means the sum of:

 (a) the fee mentioned in column 2 for the item; and

 (b) the amount mentioned in column 3 for each field separately treated in excess of one.

 

Table 5.3.1—Amount under clause 5.3.1

Item

Column 1

Item of this Schedule

Column 2

Fee

Column 3

Amount for each field separately treated in excess of one ($)

1

15003

The fee for item 15000

17.60

2

15009

The fee for item 15006

19.15

3

15103

The fee for item 15100

19.40

4

15109

The fee for item 15106

23.40

5

15115

The fee for item 15112

48.75

6

15214

The fee for item 15211

32.90

7

15230

The fee for item 15215

39.15

8

15233

The fee for item 15218

39.15

9

15236

The fee for item 15221

39.15

10

15239

The fee for item 15224

39.15

11

15242

The fee for item 15227

39.15

12

15260

The fee for item 15245

39.15

13

15263

The fee for item 15248

39.15

14

15266

The fee for item 15251

39.15

15

15269

The fee for item 15254

39.15

16

15272

The fee for item 15257

39.15

 

5.3.2  Restrictions on items 15215 to 15272—services provided to implement intensitymodulated radiation therapy dosimetry plans

  Items 15215 to 15272 do not apply to a service if the service is provided to implement an intensitymodulated radiation therapy dosimetry plan prepared in accordance with item 15565.

5.3.3  Restrictions on items 15556, 15559 and 15562

  A service described in item 15556, 15559 or 15562 applies only if:

 (a) each gross tumour target, clinical target, planning target and organ at risk specified in the prescription is rendered as a volume; and

 (b) each organ at risk is nominated as a planning dose goal or constraint; and

 (c) each organ at risk is specified in the prescription as a dose goal or constraint; and

 (d) dose volume histograms are generated, approved and recorded with the plan; and

 (e) a CT image volume dataset is required for the relevant region to be planned and treated; and

 (f) the CT image is required to be suitable for the generation of quality digitally reconstructed radiographic images.

5.3.4  Items in Group T2

  This clause sets out items in Group T2.

 

Group T2—Radiation oncology

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Superficial

15000

Radiotherapy, superficial (including treatment with xrays, radium rays or other radioactive substances), other than a service to which another item in this Group applies—attendance at which fractionated treatment is given—one field

43.90

15003

Radiotherapy, superficial (including treatment with xrays, radium rays or other radioactive substances), other than a service to which another item in this Group applies—attendance at which fractionated treatment is given—2 or more fields up to a maximum of 5 additional fields

Amount under clause 5.3.1

15006

Radiotherapy, superficial—attendance at which a single dose technique is applied—one field

97.30

15009

Radiotherapy, superficial—attendance at which a single dose technique is applied—2 or more fields up to a maximum of 5 additional fields

Amount under clause 5.3.1

15012

Radiotherapy, superficial—attendance at which treatment is given to an eye

55.10

Subgroup 2—Orthovoltage

15100

Radiotherapy, deep or orthovoltage—attendance at which fractionated treatment is given at 3 or more treatments per week—one field

49.20

15103

Radiotherapy, deep or orthovoltage—attendance at which fractionated treatment is given at 3 or more treatments per week—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)

Amount under clause 5.3.1

15106

Radiotherapy, deep or orthovoltage—attendance at which fractionated treatment is given at 2 treatments per week or less frequently—one field

58.05

15109

Radiotherapy, deep or orthovoltage—attendance at which fractionated treatment is given at 2 treatments per week or less frequently—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)

Amount under clause 5.3.1

15112

Radiotherapy, deep or orthovoltage—attendance at which a single dose technique is applied—one field

124.00

15115

Radiotherapy, deep or orthovoltage—attendance at which a single dose technique is applied—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)

Amount under clause 5.3.1

Subgroup 3—Megavoltage

15211

Radiation oncology treatment, using cobalt unit or caesium teletherapy unit—attendance at which treatment is given—one field

56.45

15214

Radiation oncology treatment, using cobalt unit or caesium teletherapy unit—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)

Amount under clause 5.3.1

15215

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site (lung)

61.50

15218

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site (prostate)

61.50

15221

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site (breast)

61.50

15224

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site for diseases or conditions not covered by item 15215, 15218 or 15221

61.50

15227

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—one field—treatment delivered to secondary site

61.50

15230

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site (lung)

Amount under clause 5.3.1

15233

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site (prostate)

Amount under clause 5.3.1

15236

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site (breast)

Amount under clause 5.3.1

15239

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site for diseases or conditions not covered by item 15230, 15233 or 15236

Amount under clause 5.3.1

15242

Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to secondary site

Amount under clause 5.3.1

15245

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site (lung)

61.50

15248

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site (prostate)

61.50

15251

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site (breast)

61.50

15254

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—one field—treatment delivered to primary site for diseases or conditions not covered by item 15245, 15248 or 15251

61.50

15257

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—one field—treatment delivered to secondary site

61.50

15260

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site (lung)

Amount under clause 5.3.1

15263

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site (prostate)

Amount under clause 5.3.1

15266

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site (breast)

Amount under clause 5.3.1

15269

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to primary site for diseases or conditions not covered by item 15260, 15263 or 15266

Amount under clause 5.3.1

15272

Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—attendance at which treatment is given—2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)—treatment delivered to secondary site

Amount under clause 5.3.1

15275

Radiation oncology treatment, with imageguided radiation therapy imaging, undertaken:

(a) to implement an intensitymodulated radiation therapy dosimetry plan prepared in accordance with item 15565; and

(b) utilising an intensitymodulated treatment delivery mode (delivered by a fixed or dynamic gantry linear accelerator or by a helical non Carm based linear accelerator)

Applicable once for each treatment

188.65

Subgroup 4—Brachytherapy

15303

Intrauterine treatment alone using radioactive sealed sources having a halflife greater than 115 days using manual afterloading techniques (Anaes.)

368.15

15304

Intrauterine treatment alone using radioactive sealed sources having a halflife greater than 115 days using automatic afterloading techniques (Anaes.)

368.15

15307

Intrauterine treatment alone using radioactive sealed sources having a halflife of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)

697.95

15308

Intrauterine treatment alone using radioactive sealed sources having a halflife of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)

697.95

15311

Intravaginal treatment alone using radioactive sealed sources having a halflife greater than 115 days using manual afterloading techniques (Anaes.)

343.65

15312

Intravaginal treatment alone using radioactive sealed sources having a halflife greater than 115 days using automatic afterloading techniques (Anaes.)

341.15

15315

Intravaginal treatment alone using radioactive sealed sources having a halflife of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)

674.65

15316

Intravaginal treatment alone using radioactive sealed sources having a halflife of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)

674.65

15319

Combined intrauterine and intravaginal treatment using radioactive sealed sources having a halflife greater than 115 days using manual afterloading techniques (Anaes.)

418.75

15320

Combined intrauterine and intravaginal treatment using radioactive sealed sources having a halflife greater than 115 days using automatic afterloading techniques (Anaes.)

418.75

15323

Combined intrauterine and intravaginal treatment using radioactive sealed sources having a halflife of less than 115 days including iodine, gold, iridium, or tantalum using manual afterloading techniques (Anaes.)

744.55

15324

Combined intrauterine and intravaginal treatment using radioactive sealed sources having a halflife of less than 115 days including iodine, gold, iridium, or tantalum using automatic afterloading techniques (Anaes.)

744.55

15327

Implantation of a sealed radioactive source (having a halflife of less than 115 days including iodine, gold, iridium or tantalum) to a region, under general anaesthesia, or epidural or spinal (intrathecal) nerve block, requiring surgical exposure and using manual afterloading techniques (Anaes.)

809.95

15328

Implantation of a sealed radioactive source (having a halflife of less than 115 days including iodine, gold, iridium or tantalum) to a region, under general anaesthesia, or epidural or spinal (intrathecal) nerve block, requiring surgical exposure and using automatic afterloading techniques (Anaes.)

809.95

15331

Implantation of a sealed radioactive source (having a halflife of less than 115 days including iodine, gold, iridium or tantalum) to a site (including the tongue, mouth, salivary gland, axilla, subcutaneous sites), if the volume treated involves multiple planes but does not require surgical exposure and using manual afterloading techniques (Anaes.)

769.10

15332

Implantation of a sealed radioactive source (having a halflife of less than 115 days including iodine, gold, iridium or tantalum) to a site (including the tongue, mouth, salivary gland, axilla, subcutaneous sites), if the volume treated involves multiple planes but does not require surgical exposure and using automatic afterloading techniques (Anaes.)

769.10

15335

Implantation of a sealed radioactive source (having a halflife of less than 115 days including iodine, gold, iridium or tantalum) to a site if the volume treated involves only a single plane but does not require surgical exposure and using manual afterloading techniques (Anaes.)

697.95

15336

Implantation of a sealed radioactive source (having a halflife of less than 115 days including iodine, gold, iridium or tantalum) to a site if the volume treated involves only a single plane but does not require surgical exposure and using automatic afterloading techniques (Anaes.)

697.95

15338

Prostate, radioactive seed implantation of, radiation oncology component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stage T1 (clinically inapparent tumour that is not palpable or visible by imaging) or clinical stage T2 (tumour confined within prostate), with a Gleason score of not more than 7 and a prostate specific antigen (PSA) of 10ng/ml or less at the time of diagnosis, if the procedure is performed by an oncologist at an approved site in association with a urologist

964.80

15339

Removal of a sealed radioactive source under general anaesthesia, or under epidural or spinal nerve block (Anaes.)

78.55

15342

Construction and application of a radioactive mould using a sealed source having a halflife of greater than 115 days, to treat intracavity, intraoral or intranasal site

196.25

15345

Construction and application of a radioactive mould using a sealed source having a halflife of less than 115 days including iodine, gold, iridium or tantalum to treat intracavity, intraoral or intranasal sites

523.65

15348

Subsequent applications of radioactive mould referred to in item 15342 or 15345—each attendance

60.25

15351

Construction with or without initial application of a radioactive mould not exceeding 5 cm in diameter to an external surface

120.25

15354

Construction and initial application of a radioactive mould more than 5 cm in diameter to an external surface

145.90

15357

Application of a radioactive mould constructed for application to an external surface of the patient other than the initial application of the mould

41.30

Subgroup 5—Computerised planning

15500

Radiation field setting using a simulator or isocentric xray or megavoltage machine or CT of a single area for treatment by a single field or parallel opposed fields (other than a service associated with a service to which item 15509 applies)

250.25

15503

Radiation field setting using a simulator or isocentric xray or megavoltage machine or CT of a single area, if views in more than one plane are required for treatment by multiple fields, or of 2 areas (other than a service associated with a service to which item 15512 applies)

321.30

15506

Radiation field setting using a simulator or isocentric xray or megavoltage machine or CT of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of offaxis fields or several joined fields (other than a service associated with a service to which item 15515 applies)

479.85

15509

Radiation field setting using a diagnostic xray unit of a single area for treatment by a single field or parallel opposed fields (other than a service associated with a service to which item 15500 applies)

216.85

15512

Radiation field setting using a diagnostic xray unit of a single area, if views in more than one plane are required for treatment by multiple fields, or of 2 areas (other than a service associated with a service to which item 15503 applies)

279.60

15513

Radiation source localisation using a simulator or xray machine or CT of a single area, if views in more than one plane are required, for brachytherapy treatment planning for Iodine 125 seed implantation of localised prostate cancer, being a service associated with a service to which item 15338 applies

316.10

15515

Radiation field setting using a diagnostic xray unit of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of offaxis fields or several joined fields (other than a service associated with a service to which item 15506 applies)

404.80

15518

Radiation dosimetry by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to one area with up to 2 shielding blocks

79.40

15521

Radiation dosimetry by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or if wedges are used

350.55

15524

Radiation dosimetry by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields or tangential fields or irregularly shaped fields using multiple blocks, or offaxis fields, or several joined fields

657.25

15527

Radiation dosimetry by a nonCT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to one area with up to 2 shielding blocks

81.40

15530

Radiation dosimetry by a nonCT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or if wedges are used

363.15

15533

Radiation Dosimetry by a nonCT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields, or tangential fields or irregularly shaped fields using multiple blocks, or offaxis fields, or several joined fields

688.60

15536

Brachytherapy planning, computerised Radiation Dosimetry

275.20

15539

Brachytherapy planning, computerised radiation dosimetry for Iodine 125 seed implantation of localised prostate cancer, being a service associated with a service to which item 15338 applies

646.90

15550

Simulation for 3 dimensional conformal radiotherapy without intravenous contrast medium if:

(a) treatment set up and technique specifications are in preparation for 3 dimensional conformal radiotherapy dose planning; and

(b) patient set up and immobilisation techniques are suitable for reliable CT image volume data acquisition and 3 dimensional conformal radiotherapy treatment; and

(c) a highquality CT image volume dataset is required for the relevant region of interest to be planned and treated; and

(d) the image set up is required to be suitable for the generation of quality digitally reconstructed radiographic images

679.20

15553

Simulation for 3 dimensional conformal radiotherapy, including pre and post intravenous contrast medium if:

(a) treatment set up and technique specifications are in preparation for 3 dimensional conformal radiotherapy dose planning; and

(b) patient set up and immobilisation techniques are suitable for reliable CT image volume data acquisition and 3 dimensional conformal radiotherapy treatment; and

(c) a highquality CT image volume dataset is required for the relevant region of interest to be planned and treated; and

(d) the image set up is required to be suitable for the generation of quality digitally reconstructed radiographic images

732.75

15555

Simulation for intensitymodulated radiation therapy, with or without intravenous contrast medium, if:

(a) treatment setup and technique specifications are in preparation for intensitymodulated radiation therapy dose planning; and

(b) patient setup and immobilisation techniques are suitable for reliable CT image volume data acquisition and intensitymodulated radiation therapy; and

(c) a highquality CT image volume dataset is acquired for the relevant region of interest to be planned and treated; and

(d) the image set is suitable for the generation of quality digitally reconstructed radiographic images

732.75

15556

Dosimetry for 3 dimensional conformal radiotherapy of level one complexity if the dosimetry is for a single phase 3 dimensional conformal treatment plan using a CT image volume dataset, with one gross tumour volume or clinical target volume, one planning target volume and one organ at risk specified in the prescription

685.20

15559

Dosimetry for 3 dimensional conformal radiotherapy of level 2 complexity if:

(a) the dosimetry is for a 2 phase 3 dimensional conformal treatment plan using one or more CT image volume datasets, with at least one gross tumour volume, 2 planning target volumes and one organ at risk specified in the prescription; or

(b) the dosimetry is for a single phase 3 dimensional conformal treatment plan using one or more CT image volume datasets, with at least one gross tumour volume, one planning target volume and 2 organ at risk dose goals or constraints specified in the prescription; or

(c) image fusion with a secondary CT, MRI or PET image volume dataset is used to define target volumes and organs at risk as mentioned in item 15556

893.60

15562

Dosimetry for 3 dimensional conformal radiotherapy of level 3 complexity if:

(a) the dosimetry is for a 3 phase 3 dimensional conformal treatment plan using one or more CT image volume datasets, with at least one gross tumour volume, 3 planning target volumes and one organ at risk specified in the prescription; or

(b) the dosimetry is for a 2 phase 3 dimensional conformal treatment plan using one or more CT image volume datasets, with:

(i) at least one gross tumour volume specified in the prescription; and

(ii) 2 planning target volumes or 2 organ at risk dose goals or constraints specified in the prescription; or

(c) the dosimetry is for a single phase 3 dimensional conformal treatment plan using one or more CT image volume datasets, with at least one gross tumour volume, one planning target volume and 3 organ at risk dose goals or constraints specified in the prescription; or

(d) image fusion with a secondary CT, MRI or PET image volume dataset is used to define target volume and organs at risk as mentioned in item 15559

1,155.80

15565

Preparation of an intensitymodulated radiation therapy dosimetry plan, which uses one or more CT image volume datasets, if:

(a) in preparing the intensitymodulated radiation therapy dosimetry plan:

(i) the differential between target dose and normal tissue dose is maximised, based on a review and assessment by a radiation oncologist; and

(ii) all gross tumour targets, clinical targets, planning targets and organs at risk are rendered as volumes as defined in the prescription; and

(iii) organs at risk are nominated as planning dose goals or constraints and the prescription specifies the organs at risk as dose goals or constraints; and

(iv) dose calculations and dose volume histograms are generated in an inverse planned process, using a specialised calculation algorithm, with prescription and plan details approved and recorded in the plan; and

(v) a CT image volume dataset is used for the relevant region to be planned and treated; and

(vi) the CT images are suitable for the generation of quality digitally reconstructed radiographic images; and

(b) the final intensitymodulated radiation therapy dosimetry plan is validated by the radiation therapist and the medical physicist, using robust quality assurance processes that include:

(i) determination of the accuracy of the dose fluence delivered by the multileaf collimator and gantry position (static or dynamic); and

(ii) ensuring that the plan is deliverable, data transfer is acceptable and validation checks are completed on a linear accelerator; and

(iii) validating the accuracy of the derived intensitymodulated radiation therapy dosimetry plan; and

(c) the final intensitymodulated radiation therapy dosimetry plan is approved by the radiation oncologist prior to delivery

3,417.35

Subgroup 6—Stereotactic radiosurgery

15600

Stereotactic radiosurgery, including all radiation oncology consultations, planning, simulation, dosimetry and treatment

1,755.50

Subgroup 7—Radiation oncology treatment verification

15700

Radiation oncology treatment verification with single projection acquisition (with single or double exposures), if:

(a) the service is prescribed and reviewed by a radiation oncologist; and

(b) the service is not associated with item 15705 or 15710;

—each attendance at which treatment is verified

47.40

15705

Radiation oncology treatment verification with multiple projection acquisition, if:

(a) the service is prescribed and reviewed by a radiation oncologist; and

(b) the service is not associated with item 15700 or item 15710;

—each attendance at which treatment involving 3 fields or more is verified

79.00

15710

Radiation oncology treatment verification with volumetric acquisition, if:

(a) the service is prescribed and reviewed by a radiation oncologist; and

(b) the service is not associated with item 15700 or item 15705;

—each attendance at which treatment involving 3 fields or more is verified

79.00

15715

Radiation oncology treatment verification of planar or volumetric imageguided radiation therapy for intensitymodulated radiation therapy, involving the use of at least 2 planar image views or projections or 1 volumetric image set to facilitate a 3dimensional adjustment to radiation treatment field positioning, if:

(a) the treatment technique is classified as intensitymodulated radiation therapy; and

(b) the margins applied to volumes (clinical target volume or planning target volume) are tailored or reduced to minimise treatment related exposure of healthy or normal tissues; and

(c) the decisions made using acquired images are based on action algorithms and are given effect immediately prior to or during treatment delivery by qualified and trained staff considering complex competing factors and using softwaredriven modelling programs; and

(d) the radiation treatment field positioning requires accuracy levels of less than 5mm (curative cases) or up to 10mm (palliative cases) to ensure accurate dose delivery to the target; and

(e) the image decisions and actions are documented in the patient’s record; and

(f) the radiation oncologist is responsible for supervising the process, including specifying the type and frequency of imaging, tolerance and action levels to be incorporated in the process, reviewing the trend analysis and any reports and relevant images during the treatment course and specifying action protocols as required; and

(g) when treatment adjustments are inadequate to satisfy treatment protocol requirements, replanning is required; and

(h) the imaging infrastructure (hardware and software) is linked to the treatment unit and networked to an image database, enabling both online and offline reviews

79.00

Subgroup 8—Brachytherapy planning and verification

15800

Brachytherapy treatment verification—once for each attendance

99.30

15850

Radiation source localisation using a simulator, xray machine, CT or ultrasound of a single area, if views in more than one plane are required, for brachytherapy treatment planning, not being a service to which item 15513 applies.

205.75

Subgroup 10—Intraoperative radiotherapy

15900

Breast, malignant tumour, targeted intraoperative radiotherapy, using an intrabeam device, delivered at the time of breastconserving surgery (partial mastectomy or lumpectomy) for a patient who:

(a) is 45 years of age or over; and

(b) has a T1 or small T2 (less than or equal to 3cm in diameter) primary tumour; and

(c) has a histologic grade 1 or 2 tumour; and

(d) has an oestrogenreceptor positive tumour; and

(e) has a node negative malignancy; and

(f) is suitable for wide local excision of a primary invasive ductal carcinoma that was diagnosed as unifocal on conventional examination and imaging; and

(g) has no contraindications to breast irradiation

(H)

257.80

 

Division 5.4Group T3: Therapeutic nuclear medicine

5.4.1  Items in Group T3

  This clause sets out items in Group T3.

 

Group T3—Therapeutic nuclear medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

16003

Intracavitary administration of a therapeutic dose of Yttrium 90 (not including preliminary paracentesis and other than a service to which item 35404, 35406 or 35408 applies or a service associated with selective internal radiation therapy) (Anaes.)

670.80

16006

Administration of a therapeutic dose of Iodine 131 for thyroid cancer by single dose technique

515.45

16009

Administration of a therapeutic dose of Iodine 131 for thyrotoxicosis by single dose technique

351.80

16012

Intravenous administration of a therapeutic dose of Phosphorous 32

304.35

16015

Administration of Strontium 89 for painful bony metastases from carcinoma of the prostate, if hormone therapy has failed and either:

(a) the disease is poorly controlled by conventional radiotherapy; or

(b) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain

4,213.30

16018

Administration of 153 Smlexidronam for the relief of bone pain due to skeletal metastases (as indicated by a positive bone scan), if hormonal therapy or chemotherapy have failed, and:

(a) the disease is poorly controlled by conventional radiotherapy; or

(b) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain

2,518.75

 

Division 5.5Group T4: Obstetrics

5.5.1  Definitions for item 16400

  In item 16400:

nurse means a person:

 (a) who is registered under a law of a State or Territory as a registered nurse or enrolled nurse; and

 (b) who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

5.5.2  Meaning of practice midwife in items 16400 and 16408

  In items 16400 and 16408:

practice midwife means a midwife who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

5.5.3  Restrictions on item 16400—provider and timing

 (1) Item 16400 applies to an antenatal service provided to a patient by a practice midwife, nurse or Aboriginal and Torres Strait Islander health practitioner only if:

 (a) the practice midwife, nurse or Aboriginal and Torres Strait Islander health practitioner has the appropriate training and skills to perform an antenatal service; and

 (b) the medical practitioner under whose supervision the antenatal service is provided retains responsibility for clinical outcomes and for the health and safety of the patient; and

 (c) the practice midwife, nurse or Aboriginal and Torres Strait Islander health practitioner complies with relevant legislative or regulatory requirements regarding the provision of the antenatal service in the State or Territory where the service is provided.

 (2) Item 16400 does not apply in conjunction with another antenatal attendance item for the same patient, on the same day by the same practitioner.

 (3) Item 16400 does not apply in conjunction with items 10990, 10991 or 10992.

 (4) For any particular patient, item 16400 applies not more than 10 times in a 9 month period.

5.5.4  Items in Group T4

  This clause sets out items in Group T4.

 

Group T4—Obstetrics

Column 1

Item

Column 2

Description

Column 3

Fee ($)

16399

Professional attendance on a patient by a specialist practising in the specialist’s specialty of obstetrics if:

(a) the attendance is by video conference; and

(b) item 16401, 16404, 16406, 16500, 16590 or 16591 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 16401, 16404, 16406, 16500, 16590 or 16591

16400

Antenatal service provided by a practice midwife, nurse or an Aboriginal and Torres Strait Islander health practitioner, applicable 10 times for a pregnancy, if:

(a) the service is provided on behalf of, and under the supervision of, a medical practitioner; and

(b) the service is provided at, or from, a practice location in a regional, rural or remote area; and

(c) the service is not performed in conjunction with another antenatal attendance item in Group T4 for the same patient on the same day by the same practitioner; and

(d) the service is not provided for an admitted patient of a hospital or approved day facility

28.10

16401

Professional attendance at consulting rooms or a hospital by a specialist in the practice of the specialist’s specialty of obstetrics after referral of the patient to the specialist—initial attendance in a single course of treatment

88.20

16404

Professional attendance at consulting rooms or a hospital by a specialist in the practice of the specialist’s specialty of obstetrics after referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment

44.35

16406

Antenatal professional attendance by an obstetrician or general practitioner, as part of a single course of treatment when the patient is referred by a participating midwife

Applicable once for a pregnancy

138.15

16407

Postnatal professional attendance (other than a service to which any other item applies) if the attendance:

(a) is by an obstetrician or general practitioner; and

(b) is in hospital or at consulting rooms; and

(c) is between 4 and 8 weeks after the birth; and

(d) lasts at least 20 minutes; and

(e) includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(f) is for a pregnancy in relation to which a service to which item 82140 applies is not provided

Applicable once for a pregnancy

73.95

16408

Postnatal attendance (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which any other item applies) if the attendance:

(a) is by:

(i) a practice midwife (on behalf of and under the supervision of the medical practitioner who attended the birth); or

(ii) an obstetrician; or

(iii) a general practitioner; and

(b) is between 1 week and 4 weeks after the birth; and

(c) lasts at least 20 minutes; and

(d) is for a patient who was privately admitted for the birth; and

(e) is for a pregnancy in relation to which a service to which item 82130, 82135 or 82140 applies is not provided

Applicable once for a pregnancy

55.05

16500

Antenatal attendance

48.60

16501

External cephalic version for breech presentation, after 36 weeks, if no contraindication exists, in a unit with facilities for caesarean section, including pre and post version CTG, with or without tocolysis, other than a service to which items 55718 to 55728 and 55768 to 55774 apply—chargeable whether or not the version is successful and limited to a maximum of 2 ECVs per pregnancy

144.95

16502

Polyhydramnios, unstable lie, multiple pregnancy, pregnancy complicated by diabetes or anaemia, threatened premature labour treated by bed rest only or oral medication, requiring admission to hospital—a professional attendance that is not a routine antenatal attendance, applicable once per day

48.60

16505

Threatened abortion, threatened miscarriage or hyperemesis gravidarum, requiring admission to hospital, treatment of—an attendance that is not a routine antenatal attendance

48.60

16508

Pregnancy complicated by acute intercurrent infection, fetal growth restriction, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital—professional attendance (other than a service to which item 16533 applies) that is not a routine antenatal attendance, applicable once per day

48.60

16509

Preeclampsia, eclampsia or antepartum haemorrhage, treatment of—professional attendance (other than a service to which item 16534 applies) that is not a routine antenatal attendance

48.60

16511

Cervix, purse string ligation of (Anaes.)

226.80

16512

Cervix, removal of purse string ligature of (Anaes.)

65.45

16514

Antenatal cardiotocography in the management of high risk pregnancy (not during the course of the confinement)

37.80

16515

Management of vaginal birth as an independent procedure, if the patient’s care has been transferred by another medical practitioner for management of the birth and the attending medical practitioner has not provided antenatal care to the patient, including all attendances related to the birth (Anaes.)

650.55

16518

Management of labour, incomplete, if the patient’s care has been transferred to another medical practitioner for completion of the birth (Anaes.)

464.70

16519

Management of labour and birth by any means (including Caesarean section) including postpartum care for 5 days (Anaes.)

715.65

16520

Caesarean section and postoperative care for 7 days, if the patient’s care has been transferred by another medical practitioner for management of the confinement and the attending medical practitioner has not provided any of the antenatal care (Anaes.)

650.55

16522

Management of labour and birth, or birth alone, (including caesarean section), on or after 23 weeks gestation, if in the course of antenatal supervision or intrapartum management one or more of the following conditions is present, including postnatal care for 7 days:

(a) fetal loss;

(b) multiple pregnancy;

(c) antepartum haemorrhage that is:

(i) of greater than 200 ml; or

(ii) associated with disseminated intravascular coagulation;

(d) placenta praevia on ultrasound in the third trimester with the placenta within 2 cm of the internal cervical os;

(e) baby with a birth weight less than or equal to 2,500 g;

(f) trial of vaginal birth in a patient with uterine scar if there has been a planned vaginal birth after caesarean section;

(g) trial of vaginal breech birth if there has been a planned vaginal breech birth;

(h) prolonged labour greater than 12 hours with partogram evidence of abnormal cervimetric progress as evidenced by cervical dilatation at less than 1 cm/hr in the active phase of labour (after 3 cm cervical dilatation and effacement until full dilatation of the cervix);

(i) acute fetal compromise evidenced by:

(i) scalp pH less than 7.15; or

(ii) scalp lactate greater than 4.0;

(j) acute fetal compromise evidenced by at least one of the following significant cardiotocograph abnormalities:

(i) prolonged bradycardia (less than 100 bpm for more than 2 minutes);

(ii) absent baseline variability (less than 3 bpm);

(iii) sinusoidal pattern;

(iv) complicated variable decelerations with reduced (3 to 5 bpm) or absent baseline variability;

(v) late decelerations;

(k) pregnancy induced hypertension of at least 140/90 mm Hg associated with:

(i) at least 2+ proteinuria on urinalysis; or

(ii) proteincreatinine ratio greater than 30 mg/mmol; or

(iii) platelet count less than 150 x 109/L; or

(iv) uric acid greater than 0.36 mmol/L;

(l) gestational diabetes mellitus requiring at least daily blood glucose monitoring;

(m) mental health disorder (whether arising prior to pregnancy, during pregnancy or postpartum) that is demonstrated by:

(i) the patient requiring hospitalisation; or

(ii) the patient receiving ongoing care by a psychologist or psychiatrist to treat the symptoms of a mental health disorder; or

(iii) the patient having a GP mental health treatment plan; or

(iv) the patient having a management plan prepared in accordance with item 291;

(n) disclosure or evidence of domestic violence;

(o) any of the following conditions either diagnosed prepregnancy or evident at the first antenatal visit before 20 weeks gestation:

(i) preexisting hypertension requiring antihypertensive medication prior to pregnancy;

(ii) cardiac disease (comanaged with a specialist physician and with echocardiographic evidence of myocardial dysfunction);

(iii) previous renal or liver transplant;

(iv) renal dialysis;

(v) chronic liver disease with documented oesophageal varices;

(vi) renal insufficiency in early pregnancy (serum creatinine greater than 110 mmol/L);

(vii) neurological disorder that confines the patient to a wheelchair throughout pregnancy;

(viii) maternal height of less than 148 cm;

(ix) a body mass index greater than or equal to 40;

(x) preexisting diabetes mellitus on medication prior to pregnancy;

(xi) thyrotoxicosis requiring medication;

(xii) previous thrombosis or thromboembolism requiring anticoagulant therapy through pregnancy and the early puerperium;

(xiii) thrombocytopenia with platelet count of less than 100,000 prior to 20 weeks gestation;

(xiv) HIV, hepatitis B or hepatitis C carrier status positive;

(xv) red cell or platelet isoimmunisation;

(xvi) cancer with metastatic disease;

(xvii) illicit drug misuse during pregnancy

(H) (Anaes.)

1,680.25

16527

Management of vaginal birth, if the patient’s care has been transferred by a participating midwife for management of the birth, including all attendances related to the birth (Anaes.)

Applicable once for a pregnancy

650.55

16528

Caesarean section and postoperative care for 7 days, if the patient’s care has been transferred by a participating midwife for management of the birth (Anaes.)

Applicable once for a pregnancy

650.55

16530

Management of pregnancy loss, from 14 weeks to 15 weeks and 6 days gestation, other than a service to which item 16531, 35640 or 35643 applies (Anaes.)

396.35

16531

Management of pregnancy loss, from 16 weeks to 22 weeks and 6 days gestation, other than a service to which item 16530, 35640 or 35643 applies (Anaes.) (H)

792.70

16533

Pregnancy complicated by acute intercurrent infection, fetal growth restriction, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital—each professional attendance lasting at least 40 minutes that is not a routine antenatal attendance, applicable 3 times for a pregnancy (H)

108.85

16534

Preeclampsia, eclampsia or antepartum haemorrhage, treatment of—each professional attendance lasting at least 40 minutes that is not a routine antenatal attendance, applicable 3 times for a pregnancy (H)

108.85

16564

Evacuation of retained products of conception (placenta, membranes or mole) as a complication of confinement, with or without curettage of the uterus, as an independent procedure (Anaes.)

224.80

16567

Management of postpartum haemorrhage by special measures such as packing of uterus, as an independent procedure (Anaes.)

328.75

16570

Acute inversion of the uterus, vaginal correction of, as an independent procedure (Anaes.)

429.05

16571

Cervix, repair of extensive laceration or lacerations (Anaes.)

328.75

16573

Third degree tear, involving anal sphincter muscles and rectal mucosa, repair of, as an independent procedure (Anaes.)

267.90

16590

Planning and management, by a practitioner, of a pregnancy if:

(a) the practitioner intends to take primary responsibility for management of the pregnancy and any complications, and to be available for the birth; and

(b) the patient intends to be privately admitted for the birth; and

(c) the pregnancy has progressed beyond 28 weeks gestation; and

(d) the practitioner has maternity privileges at a hospital or birth centre; and

(e) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(f) a service to which item 16591 applies is not provided in relation to the same pregnancy

Applicable once for a pregnancy

384.40

16591

Planning and management, by a practitioner, of a pregnancy if:

(a) the pregnancy has progressed beyond 28 weeks gestation; and

(b) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(c) a service to which item 16590 applies is not provided in relation to the same pregnancy

Applicable once for a pregnancy

147.10

16600

Amniocentesis, diagnostic

65.45

16603

Chorionic villus sampling, by any route

125.65

16606

Fetal blood sampling, using interventional techniques from umbilical cord or fetus, including fetal neuromuscular blockade and amniocentesis (Anaes.)

250.85

16609

Fetal intravascular blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling (Anaes.)

511.50

16612

Fetal intraperitoneal blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling—not performed in conjunction with a service described in item 16609 (Anaes.)

402.45

16615

Fetal intraperitoneal blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling—performed in conjunction with a service described in item 16609 (Anaes.)

214.35

16618

Amniocentesis, therapeutic, when indicated because of polyhydramnios with at least 500 ml being aspirated

214.35

16621

Amnioinfusion, for diagnostic or therapeutic purposes in the presence of severe oligohydramnios

214.35

16624

Fetal fluid filled cavity, drainage of

308.45

16627

Fetoamniotic shunt, insertion of, into fetal fluid filled cavity, including neuromuscular blockade and amniocentesis

628.00

 

Division 5.6Group T6: Examination by anaesthetist

5.6.1  Items in Group T6

  This clause sets out items in Group T6.

 

Group T6—Examination by anaesthetist

Column 1

Item

Column 2

Description

Column 3

Fee ($)

17609

Professional attendance on a patient by a specialist practising in the specialist’s specialty of anaesthesia if:

(a) the attendance is by video conference; and

(b) item 17610, 17615, 17620, 17625, 17640, 17645, 17650 or 17655 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the specialist; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

 for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 17610, 17615, 17620, 17640, 17645, 17650 or 17655

17610

Professional attendance by a medical practitioner in the practice of anaesthesia for a brief consultation involving a targeted history and limited examination, including the cardiorespiratory system, lasting not more than 15 minutes (other than a service associated with a service to which any of items 2801 to 3000 apply)

45.00

17615

Professional attendance by a medical practitioner in the practice of anaesthesia for a consultation on a patient undergoing advanced surgery or who has complex medical problems, involving a selective history and an extensive examination of multiple systems and the formulation of a written patient management plan documented in the patient notes, and lasting more than 15 minutes, but not more than 30 minutes, (other than a service associated with a service to which any of items 2801 to 3000 apply)

89.55

17620

Professional attendance by a medical practitioner in the practice of anaesthesia for a consultation on a patient undergoing advanced surgery or who has complex medical problems involving a detailed history and comprehensive examination of multiple systems, and the formulation of a written patient management plan documented in the patient notes, and lasting more than 30 minutes, but not more than 45 minutes, (other than a service associated with a service to which any of items 2801 to 3000 apply)

124.05

17625

Professional attendance by a medical practitioner in the practice of anaesthesia for a consultation on a patient undergoing advanced surgery or who has complex medical problems involving an exhaustive history and comprehensive examination of multiple systems, the formulation of a written patient management plan following discussion with relevant health care professionals and/or the patient, involving medical planning of high complexity documented in the patient notes, and lasting more than 45 minutes (other than a service associated with a service to which any of items 2801 to 3000 apply)

157.95

17640

Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to the specialist anaesthetist—a brief consultation involving a short history, a limited examination, and lasting not more than 15 minutes (other than a service associated with a service to which any of items 2801 to 3000 apply)

45.00

17645

Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to the specialist anaesthetist—a consultation involving a selective history and examination of multiple systems, the formulation of a written patient management plan, and lasting more than 15 minutes, but not more than 30 minutes, (other than a service associated with a service to which any of items 2801 to 3000 apply)

89.55

17650

Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to the specialist anaesthetist—a consultation involving a detailed history and comprehensive examination of multiple systems, and the formulation of a written patient management plan, and lasting more than 30 minutes, but not more than 45 minutes, (other than a service associated with a service to which any of items 2801 to 3000 apply)

124.05

17655

Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to the specialist anaesthetist—a consultation involving an exhaustive history and comprehensive examination of multiple systems, and the formulation of a written patient management plan following discussion with relevant health care professionals or the patient, involving medical planning of high complexity, and lasting more than 45 minutes (other than a service associated with a service to which any of items 2801 to 3000 apply)

157.95

17680

Professional attendance by a medical practitioner in the practice of anaesthesia—a consultation immediately before the institution of a major regional blockade in a patient in labour, if no previous anaesthesia consultation has occurred (other than a service associated with a service to which any of items 2801 to 3000 apply)

89.55

17690

A medical service in association with an item in the range 17615 to 17625 if:

(a) the service is provided to a patient before an admitted patient episode of care involving anaesthesia; and

(b) the service is not provided to an admitted patient of a hospital or dayhospital facility; and

(c) the service is not provided on the day of admission to hospital for the subsequent episode of care involving anaesthesia services; and

(d) the service lasts more than 15 minutes;

(other than a service associated with a service to which any of items 2801 to 3000 apply)

41.40

 

Division 5.7Group T7: Regional or field nerve blocks

5.7.1  Meaning of amount under clause 5.7.1

 (1) In item 18219:

amount under clause 5.7.1 means the sum of:

 (a) the fee for item 18216; and

 (b) $19.60 for each additional period of 15 minutes, and part of a period of 15 minutes, of continuous attendance beyond the first hour of attendance.

 (2) In item 18227:

amount under clause 5.7.1 means the sum of:

 (a) the fee for item 18226; and

 (b) $29.50 for each additional period of 15 minutes, and part of a period of 15 minutes, of continuous attendance beyond the first hour of attendance.

5.7.2  Items in Group T7

  This clause sets out items in Group T7.

 

Group T7—Regional or field nerve blocks

Column 1

Item

Column 2

Description

Column 3

Fee ($)

18213

Intravenous regional anaesthesia of limb by retrograde perfusion

91.40

18216

Intrathecal, combined spinalepidural or epidural infusion of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner (Anaes.)

195.85

18219

Intrathecal, combined spinalepidural or epidural infusion of a therapeutic substance, initial injection or commencement of, if continuous attendance by the medical practitioner extends beyond the first hour (Anaes.)

Amount under clause 5.7.1

18222

Infusion of a therapeutic substance to maintain regional anaesthesia or analgesia, subsequent injection or revision of, if the period of continuous medical practitioner attendance is 15 minutes or less

38.80

18225

Infusion of a therapeutic substance to maintain regional anaesthesia or analgesia, subsequent injection or revision of, if the period of continuous medical practitioner attendance is more than 15 minutes

51.60

18226

Intrathecal, combined spinalepidural or epidural infusion of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner—for a patient in labour, if the service is provided between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday

293.70

18227

Intrathecal, combined spinalepidural or epidural infusion of a therapeutic substance, initial injection or commencement of, if continuous attendance by a medical practitioner extends beyond the first hour—for a patient in labour, if the service is provided between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday

Amount under clause 5.7.1

18228

Interpleural block, initial injection or commencement of infusion of a therapeutic substance

64.45

18230

Intrathecal or epidural injection of neurolytic substance (Anaes.)

245.90

18232

Intrathecal or epidural injection of substance other than anaesthetic, contrast or neurolytic solutions, other than a service to which another item in this Group applies (Anaes.)

195.85

18233

Epidural injection of blood for blood patch (Anaes.)

195.85

18234

Trigeminal nerve, primary division of, injection of an anaesthetic agent (Anaes.)

128.75

18236

Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent (Anaes.)

64.45

18238

Facial nerve, injection of an anaesthetic agent, other than a service associated with a service to which item 18240 applies

38.80

18240

Retrobulbar or peribulbar injection of an anaesthetic agent

96.55

18242

Greater occipital nerve, injection of an anaesthetic agent (Anaes.)

38.80

18244

Vagus nerve, injection of an anaesthetic agent

103.95

18248

Phrenic nerve, injection of an anaesthetic agent

91.40

18250

Spinal accessory nerve, injection of an anaesthetic agent

64.45

18252

Cervical plexus, injection of an anaesthetic agent

103.95

18254

Brachial plexus, injection of an anaesthetic agent

103.95

18256

Suprascapular nerve, injection of an anaesthetic agent

64.45

18258

Intercostal nerve (single), injection of an anaesthetic agent

64.45

18260

Intercostal nerves (multiple), injection of an anaesthetic agent

91.40

18262

Ilioinguinal, iliohypogastric or genitofemoral nerves, one or more of, injections of an anaesthetic agent (Anaes.)

64.45

18264

Pudendal nerve or dorsal nerve (or both), injection of an anaesthetic agent

103.95

18266

Ulnar, radial or median nerve, main trunk of, one or more of, injections of an anaesthetic agent, not being associated with a brachial plexus block

64.45

18268

Obturator nerve, injection of an anaesthetic agent

91.40

18270

Femoral nerve, injection of an anaesthetic agent

91.40

18272

Saphenous, sural, popliteal or posterior tibial nerve, main trunk of, one or more of, injections of an anaesthetic agent

64.45

18274

Paravertebral, cervical, thoracic, lumbar, sacral or coccygeal nerves, injection of an anaesthetic agent, (single vertebral level)

91.40

18276

Paravertebral nerves, injection of an anaesthetic agent, (multiple levels)

128.75

18278

Sciatic nerve, injection of an anaesthetic agent

91.40

18280

Sphenopalatine ganglion, injection of an anaesthetic agent (Anaes.)

128.75

18282

Carotid sinus, injection of an anaesthetic agent, as an independent percutaneous procedure

103.95

18284

Stellate ganglion, injection of an anaesthetic agent (cervical sympathetic block) (Anaes.)

152.25

18286

Lumbar or thoracic nerves, injection of an anaesthetic agent (paravertebral sympathetic block) (Anaes.)

152.25

18288

Coeliac plexus or splanchnic nerves, injection of an anaesthetic agent (Anaes.)

152.25

18290

Cranial nerve other than trigeminal, destruction by a neurolytic agent, other than a service associated with the injection of botulinum toxin (Anaes.)

257.55

18292

Nerve branch, destruction by a neurolytic agent, other than a service to which another item in this Group applies or a service associated with the injection of botulinum toxin except a service to which item 18354 applies (Anaes.)

128.75

18294

Coeliac plexus or splanchnic nerves, destruction by a neurolytic agent (Anaes.)

181.50

18296

Lumbar sympathetic chain, destruction by a neurolytic agent (Anaes.)

155.25

18297

Assistance at the administration of an epidural blood patch (a service to which item 18233 applies) by another medical practitioner

61.20

18298

Cervical or thoracic sympathetic chain, destruction by a neurolytic agent (Anaes.)

181.50

 

Division 5.8Group T11: Botulinum toxin

5.8.1  Group T11 services do not include supply of botulinum toxin

  A service described in any of items 18350 to 18379 does not include the supply of the botulinum toxin to which the service relates.

5.8.2  Restrictions on items in Group T11

 (1) Items 18350 to 18354, 18361, 18362 and 18369 to 18379 do not apply to an injection of botulinum toxin if the botulinum toxin is not supplied under the pharmaceutical benefits scheme.

 (2) A service described in item 18360 is applicable to the first 4 treatments, not exceeding 2 for each limb, on any one day.

 (3) Items 18360, 18366 and 18368 apply only to a service provided by a specialist or consultant physician in the practice of the specialist’s or consultant physician’s speciality.

5.8.3  Items in Group T11

  This clause sets out items in Group T11.

 

Group T11—Botulinum toxin

Column 1

Item

Column 2

Description

Column 3

Fee ($)

18350

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of hemifacial spasm in a patient who is at least 12 years of age, including all such injections on any one day

128.75

18351

Clostridium Botulinum Type A ToxinHaemagglutinin Complex (Dysport), injection of, for the treatment of hemifacial spasm in a patient who is at least 18 years of age, including all such injections on any one day

128.75

18353

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A ToxinHaemagglutinin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of cervical dystonia (spasmodic torticollis), including all such injections on any one day

257.55

18354

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A ToxinHaemagglutinin Complex (Dysport), injection of, for the treatment of dynamic equinus foot deformity (including equinovarus and equinovulgus) due to spasticity in an ambulant cerebral palsy patient, if:

(a) the patient is at least 2 years of age; and

(b) the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve, with a maximum of 4 sets of injections for the patient on any one day (with a maximum of 2 sets of injections for each lower limb), including all injections per set (Anaes.)

128.75

18360

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin Haemagglutinin Complex (Dysport), injection of, for the treatment of moderate to severe focal spasticity if:

(a) the patient is at least 18 years of age; and

(b) the spasticity is associated with a previously diagnosed neurological disorder; and

(c) the treatment is provided as:

(i) second line therapy when standard treatment for the condition has failed; or

(ii) an adjunct to physical therapy; and

(d) the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve, with a maximum of 4 sets of injections for the patient on any one day (with a maximum of 2 sets of injections for each limb), including all injections per set

128.75

18361

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of moderate to severe upper limb spasticity due to cerebral palsy if:

(a) the patient is at least 2 years of age; and

(b) for a patient who is at least 18 years of age—before the patient turned 18, the patient had commenced treatment for the spasticity with botulinum toxin supplied under the pharmaceutical benefits scheme; and

(c) the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve, with a maximum of 4 sets of injections for the patient on any one day (with a maximum of 2 sets of injections for each upper limb), including all injections per set (Anaes.)

128.75

18362

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of severe primary axillary hyperhidrosis, including all such injections on any one day, if:

(a) the patient is at least 12 years of age; and

(b) the patient has been intolerant of, or has not responded to, topical aluminium chloride hexahydrate; and

(c) the patient has not had treatment with botulinum toxin within the immediately preceding 4 months; and

(d) if the patient has had treatment with botulinum toxin within the previous 12 months—the patient had treatment on no more than 2 separate occasions (Anaes.)

254.40

18366

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of strabismus, including all such injections on any one day and associated electromyography (Anaes.)

161.30

18368

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of spasmodic dysphonia, including all such injections on any one day

275.35

18369

Clostridium Botulinum Type A ToxinHaemagglutinin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of unilateral blepharospasm in a patient who is at least 18 years of age, including all such injections on any one day (Anaes.)

46.45

18370

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for unilateral blepharospasm in a patient who is at least 12 years of age, including all such injections on any one day (Anaes.)

46.45

18372

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of bilateral blepharospasm, in a patient who is at least 12 years of age, including all such injections on any one day (Anaes.)

128.75

18374

Clostridium Botulinum Type A ToxinHaemagglutinin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of bilateral blepharospasm in a patient who is at least 18 years of age, including all such injections on any one day (Anaes.)

128.75

18375

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), intravesial injection of, with cystoscopy, for the treatment of urinary incontinence, including all such injections on any one day, if:

(a) the urinary incontinence is due to neurogenic detrusor overactivity as demonstrated by urodynamic study of a patient with:

(i) multiple sclerosis; or

(ii) spinal cord injury; or

(iii) for a patient who is at least 18 years of age—spina bifida; and

(b) the patient has urinary incontinence that is inadequately controlled by anticholinergic therapy, as manifested by having experienced at least 14 episodes of urinary incontinence per week before commencement of treatment; and

(c) the patient is willing and able to selfcatheterise; and

(d) the treatment is not provided on the same occasion as a service described in item 104, 105, 110, 116, 119, 11900 or 11919

Applicable only once unless the patient achieves at least a 50% reduction in urinary incontinence episodes from baseline at any time during the period of 6 to 12 weeks after first treatment

(H) (Anaes.)

237.05

18377

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of chronic migraine, including all injections in one day, if:

(a) the patient is at least 18 years of age; and

(b) the patient has experienced an inadequate response, intolerance or contraindication to at least 3 prophylactic migraine medications before commencement of treatment with botulinum toxin, as manifested by an average of 15 or more headache days per month, with at least 8 days of migraine, over a period of at least 6 months, before commencement of treatment with botulinum toxin

Applicable not more than twice unless the patient achieves and maintains at least a 50% reduction in the number of headache days per month from baseline after 2 cycles of treatment (each of 12 weeks)

128.75

18379

Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), intravesial injection of, with cystoscopy, for the treatment of urinary incontinence, including all such injections on any one day, if:

(a) the urinary incontinence is due to idiopathic overactive bladder in a patient; and

(b) the patient is at least 18 years of age; and

(c) the patient has urinary incontinence that is inadequately controlled by at least 2 alternative anticholinergic agents, as manifested by having experienced at least 14 episodes of urinary incontinence per week before commencement of treatment with botulinum toxin; and

(d) the patient is willing and able to selfcatheterise; and

(e) treatment is not provided on the same occasion as a service described in item 104, 105, 110, 116, 119, 11900 or 11919

Applicable only once unless the patient achieves at least a 50% reduction in urinary incontinence episodes from baseline at any time during the period of 6 to 12 weeks after first treatment

(H) (Anaes.)

237.05

 

Division 5.9Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)

5.9.1  Meaning of amount under clause 5.9.1

 (1) In item 25025:

amount under clause 5.9.1 means 50% of the sum of:

 (a) the fee mentioned in any of items 20100 to 21997 or 22900 for the initiation of the management of anaesthesia in association with which the anaesthesia is performed; and

 (b) the fee mentioned in the item in the range 23010 to 24136 that applies to the anaesthesia; and

 (c) if any of items 25000 to 25014 applies to the anaesthesia—the fee mentioned in the item; and

 (d) if a service described in any of items 22002 to 22051 is performed in association with the anaesthesia—the fee mentioned in the item.

 (2) In item 25030:

amount under clause 5.9.1 means 50% of the sum of:

 (a) the fee mentioned in the item in the range 25200 to 25205 that applies to the assistance; and

 (b) the fee mentioned in the item in the range 23010 to 24136 that applies to the assistance; and

 (c) if any of items 25000 to 25014 applies to the anaesthesia—the fee mentioned in the item; and

 (d) if a service described in any of items 22002 to 22051 is performed in association with the assistance—the fee mentioned in the item.

 (3) In item 25050:

amount under clause 5.9.1 means 50% of the sum of:

 (a) the fee mentioned in item 22060; and

 (b) the fee mentioned in the item in the range 23010 to 24136 that applies to the perfusion; and

 (c) if any of items 25000 to 25014 apply to the perfusion—the fee mentioned in the item; and

 (d) if a service described in any of items 22002 to 22051 or 22065 to 22075 is performed in association with the perfusion—the fee mentioned in the item.

5.9.2  Meaning of amount under clause 5.9.2

In items 25200 and 25205:

amount under clause 5.9.2 means the sum of:

 (a) $102.00; and

 (b) the fee mentioned in the item in the range 23010 to 24136 that applies to the assistance; and

 (c) if any of the items 25000 to 25020 applies to the assistance—the fee mentioned in the item; and

 (d) if a service described in an item in the range 22002 to 22051 applies to the assistance—the fee mentioned in the item.

5.9.3  Meaning of service time

  In Subgroups 21, 24, 25 and 26 of Group T10:

service time means:

 (a) for the management of anaesthesia on a patient by an anaesthetist—the period that:

 (i) starts when the anaesthetist commences exclusive and continuous care of the patient for anaesthesia; and

 (ii) ends when the anaesthetist places the patient safely under the supervision of other personnel; and

 (b) for perfusion performed on a patient under anaesthesia—the period that:

 (i) starts when the anaesthetic commences; and

 (ii) ends with the closure of the chest of the patient; and

 (c) for assistance given by an assistant anaesthetist in the management of anaesthesia performed on a patient—the period when the assistant anaesthetist is actively attending on the patient.

5.9.4  Restrictions on items in Group T10

Items applying only to services connected with services described using “(Anaes.)”

 (1) Items 20100 to 21990 (other than item 21965), 22060, 23010 to 24136, 25200 and 25205 apply to a service only if the service is provided in connection with a service that:

 (a) is a professional service within the meaning of subsection 3(1) of the Act; and

 (b) is mentioned in an item that includes, in its description, “(Anaes.)”.

Items 22900 and 22905 applying only to services connected with dental services

 (2) Items 22900 and 22905 apply to a service only if the service is provided in connection with a dental service (other than a dental service that is a prescribed medical service under paragraph (b) of the definition of professional service in subsection 3(1) of the Act).

Services associated with certain diagnostic imaging services

 (3) An item in Group T10 does not apply to a service described in the item if the service is claimed in association with a service to which item 55026 or 55054 of the diagnostic imaging services table applies.

5.9.5  Application of Subgroup 21 of Group T10

 (1) Items 23010 to 24136 apply to perfusion.

 (2) Items 23010 to 24136 apply to assistance only as a component of item 25200 or 25205 and for the purpose of calculating the amount of fee for that item.

5.9.6  Meaning of anaesthesia, assistance and perfusion in Subgroups 21 to 25 of Group T10

  In Subgroups 21 to 25 of Group T10:

anaesthesia means the management of anaesthesia performed in association with a service to which any of items 20100 to 21997, 22900 and 22905 applies.

assistance means assistance:

 (a) in the management of anaesthesia; and

 (b) to which item 25200 or 25205 applies.

perfusion means perfusion to which item 22060 applies.

5.9.7  Application of Subgroups 22 and 23 of Group T10

 (1) Items 25000 to 25020 apply to anaesthesia in addition to any other item that applies to anaesthesia.

 (2) Items 25000 to 25020 apply to perfusion in addition to any other item that applies to perfusion.

 (3) Items 25000 to 25020 apply:

 (a) to assistance only as a component of item 25200 or 25205; and

 (b) for calculating the amount of fee for the item.

5.9.8  Application of Subgroups 24 and 25 of Group T10

  Items 25025 to 25050 apply to anaesthesia, assistance or perfusion in addition to any other item that applies to the service.

5.9.9  Items in Group T10

  This clause sets out items in Group T10.

 

Group T10—Anaesthesia performed in connection with certain services (Relative Value Guide)

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Head

20100

Initiation of the management of anaesthesia for procedures on the skin, subcutaneous tissue, muscles, salivary glands or superficial vessels of the head, including biopsy, other than a service to which another item in this Subgroup applies

102.00

20102

Initiation of the management of anaesthesia for plastic repair of cleft lip

122.40

20104

Initiation of the management of anaesthesia for electroconvulsive therapy

81.60

20120

Initiation of the management of anaesthesia for procedures on external, middle or inner ear, including biopsy, other than a service to which another item in this Subgroup applies

102.00

20124

Initiation of the management of anaesthesia for otoscopy

81.60

20140

Initiation of the management of anaesthesia for procedures on eye, other than a service to which another item in this Subgroup applies

102.00

20142

Initiation of the management of anaesthesia for lens surgery

102.00

20143

Initiation of the management of anaesthesia for retinal surgery

122.40

20144

Initiation of the management of anaesthesia for corneal transplant

142.80

20145

Initiation of the management of anaesthesia for vitrectomy

142.80

20146

Initiation of the management of anaesthesia for biopsy of conjunctiva

102.00

20147

Initiation of the management of anaesthesia for squint repair

122.40

20148

Initiation of the management of anaesthesia for ophthalmoscopy

81.60

20160

Initiation of the management of anaesthesia for intranasal procedures on nose or accessory sinuses, other than a service to which another item in this Subgroup applies

122.40

20162

Initiation of the management of anaesthesia for intranasal surgery for malignancy or for intranasal ablation

142.80

20164

Initiation of the management of anaesthesia for biopsy of soft tissue of the nose and accessory sinuses

81.60

20170

Initiation of the management of anaesthesia for intraoral procedures, including biopsy, other than a service to which another item in this Subgroup applies

122.40

20172

Initiation of the management of anaesthesia for repair of cleft palate

142.80

20174

Initiation of the management of anaesthesia for excision of retropharyngeal tumour

183.60

20176

Initiation of the management of anaesthesia for radical intraoral surgery

204.00

20190

Initiation of the management of anaesthesia for procedures on facial bones, other than a service to which another item in this Subgroup applies

102.00

20192

Initiation of the management of anaesthesia for extensive surgery on facial bones (including prognathism and extensive facial bone reconstruction)

204.00

20210

Initiation of the management of anaesthesia for intracranial procedures, other than a service to which another item in this Subgroup applies

306.00

20212

Initiation of the management of anaesthesia for subdural taps

102.00

20214

Initiation of the management of anaesthesia for burr holes of the cranium

183.60

20216

Initiation of the management of anaesthesia for intracranial vascular procedures, including those for aneurysms or arteriovenous abnormalities

408.00

20220

Initiation of the management of anaesthesia for spinal fluid shunt procedures

204.00

20222

Initiation of the management of anaesthesia for ablation of an intracranial nerve

122.40

20225

Initiation of the management of anaesthesia for all cranial bone procedures

244.80

20230

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the head or face

244.80

Subgroup 2—Neck

20300

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the neck, other than a service to which another item in this Subgroup applies

102.00

20305

Initiation of the management of anaesthesia for incision and drainage of large haematoma, large abscess, cellulitis or similar lesion or epiglottitis, causing life threatening airway obstruction

306.00

20320

Initiation of the management of anaesthesia for procedures on oesophagus, thyroid, larynx, trachea, lymphatic system, muscles, nerves or other deep tissues of the neck, other than a service to which another item in this Subgroup applies

122.40

20321

Initiation of the management of anaesthesia for laryngectomy, hemi laryngectomy, laryngopharyngectomy or pharyngectomy

204.00

20330

Initiation of the management of anaesthesia for laser surgery to the airway (excluding nose and mouth)

163.20

20350

Initiation of the management of anaesthesia for procedures on major vessels of neck, other than a service to which another item in this Subgroup applies

204.00

20352

Initiation of the management of anaesthesia for simple ligation of major vessels of neck

102.00

20355

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the neck

244.80

Subgroup 3—Thorax

20400

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the anterior part of the chest, other than a service to which another item in this Subgroup applies

61.20

20401

Initiation of the management of anaesthesia for procedures on the breast, other than a service to which another item in this Subgroup applies

81.60

20402

Initiation of the management of anaesthesia for reconstructive procedures on breast

102.00

20403

Initiation of the management of anaesthesia for removal of breast lump or for breast segmentectomy, if axillary node dissection is performed

102.00

20404

Initiation of the management of anaesthesia for mastectomy

122.40

20405

Initiation of the management of anaesthesia for reconstructive procedures on the breast using myocutaneous flaps

163.20

20406

Initiation of the management of anaesthesia for radical or modified radical procedures on breast with internal mammary node dissection

265.20

20410

Initiation of the management of anaesthesia for electrical conversion of arrhythmias

81.60

20420

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the posterior part of the chest, other than a service to which another item in this Subgroup applies

102.00

20440

Initiation of the management of anaesthesia for percutaneous bone marrow biopsy of the sternum

81.60

20450

Initiation of the management of anaesthesia for procedures on clavicle, scapula or sternum, other than a service to which another item in this Subgroup applies

102.00

20452

Initiation of the management of anaesthesia for radical surgery on clavicle, scapula or sternum

122.40

20470

Initiation of the management of anaesthesia for partial rib resection, other than a service to which another item in this Subgroup applies

122.40

20472

Initiation of the management of anaesthesia for thoracoplasty

204.00

20474

Initiation of the management of anaesthesia for radical procedures on chest wall

265.20

20475

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior thorax

204.00

Subgroup 4—Intrathoracic

20500

Initiation of the management of anaesthesia for open procedures on the oesophagus

306.00

20520

Initiation of the management of anaesthesia for all closed chest procedures (including rigid oesophagoscopy or bronchoscopy), other than a service to which another item in this Subgroup applies

122.40

20522

Initiation of the management of anaesthesia for needle biopsy of pleura

81.60

20524

Initiation of the management of anaesthesia for pneumocentesis

81.60

20526

Initiation of the management of anaesthesia for thoracoscopy

204.00

20528

Initiation of the management of anaesthesia for mediastinoscopy

163.20

20540

Initiation of the management of anaesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, or mediastinum, other than a service to which another item in this Subgroup applies

265.20

20542

Initiation of the management of anaesthesia for pulmonary decortication

306.00

20546

Initiation of the management of anaesthesia for pulmonary resection with thoracoplasty

306.00

20548

Initiation of the management of anaesthesia for intrathoracic repair of trauma to trachea and bronchi

306.00

20560

Initiation of the management of anaesthesia for:

(a) open procedures on the heart, pericardium or great vessels of the chest; or

(b) percutaneous insertion of a valvular prosthesis

408.00

Subgroup 5—Spine and spinal cord

20600

Initiation of the management of anaesthesia for procedures on cervical spine or spinal cord, or both, other than a service to which another item in this Subgroup applies

204.00

20604

Initiation of the management of anaesthesia for posterior cervical laminectomy with the patient in the sitting position

265.20

20620

Initiation of the management of anaesthesia for procedures on thoracic spine or spinal cord, or both, other than a service to which another item in this Subgroup applies

204.00

20622

Initiation of the management of anaesthesia for thoracolumbar sympathectomy

265.20

20630

Initiation of the management of anaesthesia for procedures in lumbar region, other than a service to which another item in this Subgroup applies

163.20

20632

Initiation of the management of anaesthesia for lumbar sympathectomy

142.80

20634

Initiation of the management of anaesthesia for chemonucleolysis

204.00

20670

Initiation of the management of anaesthesia for extensive spine or spinal cord procedures, or both

265.20

20680

Initiation of the management of anaesthesia for manipulation of spine when performed in the operating theatre of a hospital

61.20

20690

Initiation of the management of anaesthesia for percutaneous spinal procedures, other than a service to which another item in this Subgroup applies

102.00

Subgroup 6—Upper abdomen

20700

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the upper anterior abdominal wall, other than a service to which another item in this Subgroup applies

61.20

20702

Initiation of the management of anaesthesia for percutaneous liver biopsy

81.60

20703

Initiation of the management of anaesthesia for procedures on the nerves, muscles, tendons and fascia of the upper abdominal wall, other than a service to which another item in this Subgroup applies

81.60

20704

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior upper abdomen

204.00

20706

Initiation of the management of anaesthesia for laparoscopic procedures in the upper abdomen, including laparoscopic cholecystectomy, other than a service to which another item in this Subgroup applies

142.80

20730

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the upper posterior abdominal wall, other than a service to which another item in this Subgroup applies

102.00

20740

Initiation of the management of anaesthesia for upper gastrointestinal endoscopic procedures

102.00

20745

Initiation of the management of anaesthesia for either or both of the following:

(a) upper gastrointestinal endoscopic procedures in association with acute gastrointestinal haemorrhage;

(b) endoscopic retrograde cholangiopancreatography

142.80

20750

Initiation of the management of anaesthesia for hernia repairs to the upper abdominal wall, other than a service to which another item in this Subgroup applies

102.00

20752

Initiation of the management of anaesthesia for repair of incisional hernia or wound dehiscence, or both

122.40

20754

Initiation of the management of anaesthesia for procedures on an omphalocele

142.80

20756

Initiation of the management of anaesthesia for transabdominal repair of diaphragmatic hernia

183.60

20770

Initiation of the management of anaesthesia for procedures on major upper abdominal blood vessels

306.00

20790

Initiation of the management of anaesthesia for procedures within the peritoneal cavity in the upper abdomen, including any of the following:

(a) open cholecystectomy;

(b) gastrectomy;

(c) laparoscopic assisted nephrectomy;

(d) bowel shunts

163.20

20791

Initiation of the management of anaesthesia for bariatric surgery in a patient with clinically severe obesity

204.00

20792

Initiation of the management of anaesthesia for partial hepatectomy (excluding liver biopsy)

265.20

20793

Initiation of the management of anaesthesia for extended or trisegmental hepatectomy

306.00

20794

Initiation of the management of anaesthesia for pancreatectomy, partial or total

244.80

20798

Initiation of the management of anaesthesia for neuro endocrine tumour removal in the upper abdomen

204.00

20799

Initiation of the management of anaesthesia for percutaneous procedures on an intraabdominal organ in the upper abdomen

122.40

Subgroup 7—Lower abdomen

20800

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the lower anterior abdominal walls, other than a service to which another item in this Subgroup applies

61.20

20802

Initiation of the management of anaesthesia for lipectomy of the lower abdomen

102.00

20803

Initiation of the management of anaesthesia for procedures on the nerves, muscles, tendons and fascia of the lower abdominal wall, other than a service to which another item in this Subgroup applies

81.60

20804

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior lower abdomen

204.00

20806

Initiation of the management of anaesthesia for laparoscopic procedures in the lower abdomen

142.80

20810

Initiation of the management of anaesthesia for lower intestinal endoscopic procedures

81.60

20815

Initiation of the management of anaesthesia for extracorporeal shock wave lithotripsy to urinary tract

122.40

20820

Initiation of the management of anaesthesia for procedures on the skin, its derivatives or subcutaneous tissue of the lower posterior abdominal wall

102.00

20830

Initiation of the management of anaesthesia for hernia repairs in lower abdomen, other than a service to which another item in this Subgroup applies

81.60

20832

Initiation of the management of anaesthesia for repair of incisional herniae or wound dehiscence, or both, of the lower abdomen

122.40

20840

Initiation of the management of anaesthesia for all open procedures within the peritoneal cavity in the lower abdomen, including appendicectomy, other than a service to which another item in this Subgroup applies

122.40

20841

Initiation of the management of anaesthesia for bowel resection, including laparoscopic bowel resection, other than a service to which another item in this Subgroup applies

163.20

20842

Initiation of the management of anaesthesia for amniocentesis

81.60

20844

Initiation of the management of anaesthesia for abdominoperineal resection, including pull through procedures, ultra low anterior resection and formation of bowel reservoir

204.00

20845

Initiation of the management of anaesthesia for radical prostatectomy

204.00

20846

Initiation of the management of anaesthesia for radical hysterectomy

204.00

20847

Initiation of the management of anaesthesia for ovarian malignancy

204.00

20848

Initiation of the management of anaesthesia for pelvic exenteration

204.00

20850

Initiation of the management of anaesthesia for caesarean section

244.80

20855

Initiation of the management of anaesthesia for caesarean hysterectomy or hysterectomy within 24 hours of birth

306.00

20860

Initiation of the management of anaesthesia for extraperitoneal procedures in lower abdomen, including those on the urinary tract, other than a service to which another item in this Subgroup applies

122.40

20862

Initiation of the management of anaesthesia for renal procedures, including upper onethird of ureter

142.80

20863

Initiation of the management of anaesthesia for nephrectomy

204.00

20864

Initiation of the management of anaesthesia for total cystectomy

204.00

20866

Initiation of the management of anaesthesia for adrenalectomy

204.00

20867

Initiation of the management of anaesthesia for neuro endocrine tumour removal in the lower abdomen

204.00

20868

Initiation of the management of anaesthesia for renal transplantation (donor or recipient)

204.00

20880

Initiation of the management of anaesthesia for procedures on major lower abdominal vessels, other than a service to which another item in this Subgroup applies

306.00

20882

Initiation of the management of anaesthesia for inferior vena cava ligation

204.00

20884

Initiation of the management of anaesthesia for percutaneous umbrella insertion

102.00

20886

Initiation of the management of anaesthesia for percutaneous procedures on an intraabdominal organ in the lower abdomen

122.40

Subgroup 8—Perineum

20900

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the perineum, other than a service to which another item in this Subgroup applies

61.20

20902

Initiation of the management of anaesthesia for anorectal procedures (including surgical haemorrhoidectomy, but not banding of haemorrhoids)

81.60

20904

Initiation of the management of anaesthesia for radical perineal procedures, including radical perineal prostatectomy or radical vulvectomy

142.80

20905

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the perineum

204.00

20906

Initiation of the management of anaesthesia for vulvectomy

81.60

20910

Initiation of the management of anaesthesia for transurethral procedures (including urethrocyctoscopy), other than a service to which another item in this Subgroup applies

81.60

20911

Initiation of the management of anaesthesia for endoscopic ureteroscopic surgery including laser procedures

102.00

20912

Initiation of the management of anaesthesia for transurethral resection of bladder tumour or tumours

102.00

20914

Initiation of the management of anaesthesia for transurethral resection of prostate

142.80

20916

Initiation of the management of anaesthesia for bleeding posttransurethral resection

142.80

20920

Initiation of the management of anaesthesia for procedures on external genitalia, other than a service to which another item in this Subgroup applies

81.60

20924

Initiation of the management of anaesthesia for procedures on undescended testis, unilateral or bilateral

81.60

20926

Initiation of the management of anaesthesia for radical orchidectomy, inguinal approach

81.60

20928

Initiation of the management of anaesthesia for radical orchidectomy, abdominal approach

122.40

20930

Initiation of the management of anaesthesia for orchiopexy, unilateral or bilateral

81.60

20932

Initiation of the management of anaesthesia for complete amputation of penis

81.60

20934

Initiation of the management of anaesthesia for complete amputation of penis with bilateral inguinal lymphadenectomy

122.40

20936

Initiation of the management of anaesthesia for complete amputation of penis with bilateral inguinal and iliac lymphadenectomy

163.20

20938

Initiation of the management of anaesthesia for insertion of penile prosthesis

81.60

20940

Initiation of the management of anaesthesia for per vagina and vaginal procedures (including biopsy of vagina, cervix or endometrium), other than a service to which another item in this Subgroup applies

81.60

20942

Initiation of the management of anaesthesia for vaginal procedures (including repair operations and urinary incontinence procedures)

102.00

20943

Initiation of the management of anaesthesia for transvaginal assisted reproductive services

81.60

20944

Initiation of the management of anaesthesia for vaginal hysterectomy

122.40

20946

Initiation of the management of anaesthesia for vaginal birth

163.20

20948

Initiation of the management of anaesthesia for purse string ligation of cervix, or removal of purse string ligature, or removal of purse string ligature

81.60

20950

Initiation of the management of anaesthesia for culdoscopy

102.00

20952

Initiation of the management of anaesthesia for hysteroscopy

81.60

20954

Initiation of the management of anaesthesia for correction of inverted uterus

204.00

20956

Initiation of the management of anaesthesia for evacuation of retained products of conception, as a complication of confinement

81.60

20958

Initiation of the management of anaesthesia for manual removal of retained placenta or for repair of vaginal or perineal tear following birth

102.00

20960

Initiation of the management of anaesthesia for vaginal procedures in the management of postpartum haemorrhage, if the blood loss is greater than 500 ml

142.80

Subgroup 9—Pelvis (except hip)

21100

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the anterior pelvic region (anterior to iliac crest), except external genitalia

61.20

21110

Initiation of the management of anaesthesia for procedures on the skin, its derivatives or subcutaneous tissue of the pelvic region (posterior to iliac crest), except perineum

102.00

21112

Initiation of the management of anaesthesia for percutaneous bone marrow biopsy of the anterior iliac crest

81.60

21114

Initiation of the management of anaesthesia for percutaneous bone marrow biopsy of the posterior iliac crest

102.00

21116

Initiation of the management of anaesthesia for percutaneous bone marrow harvesting from the pelvis

122.40

21120

Initiation of the management of anaesthesia for procedures on the bony pelvis

122.40

21130

Initiation of the management of anaesthesia for body cast application or revision, when performed in the operating theatre of a hospital

61.20

21140

Initiation of the management of anaesthesia for interpelviabdominal (hindquarter) amputation

306.00

21150

Initiation of the management of anaesthesia for radical procedures for tumour of the pelvis, except hindquarter amputation

204.00

21155

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior pelvis

204.00

21160

Initiation of the management of anaesthesia for closed procedures involving symphysis pubis or sacroiliac joint, when performed in the operating theatre of a hospital

81.60

21170

Initiation of the management of anaesthesia for open procedures involving symphysis pubis or sacroiliac joint

163.20

Subgroup 10—Upper leg (except knee)

21195

Initiation of the management of anaesthesia for procedures on the skins or subcutaneous tissue of the upper leg

61.20

21199

Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of the upper leg

81.60

21200

Initiation of the management of anaesthesia for closed procedures involving hip joint, when performed in the operating theatre of a hospital

81.60

21202

Initiation of the management of anaesthesia for arthroscopic procedures of the hip joint

81.60

21210

Initiation of the management of anaesthesia for open procedures involving hip joint, other than a service to which another item in this Subgroup applies

122.40

21212

Initiation of the management of anaesthesia for hip disarticulation

204.00

21214

Initiation of the management of anaesthesia for total hip replacement or revision

204.00

21216

Initiation of the management of anaesthesia for bilateral total hip replacement

285.60

21220

Initiation of the management of anaesthesia for closed procedures involving upper twothirds of femur, when performed in the operating theatre of a hospital

81.60

21230

Initiation of the management of anaesthesia for open procedures involving upper twothirds of femur, other than a service to which another item in this Subgroup applies

122.40

21232

Initiation of the management of anaesthesia for above knee amputation

102.00

21234

Initiation of the management of anaesthesia for radical resection of the upper twothirds of femur

163.20

21260

Initiation of the management of anaesthesia for procedures involving veins of upper leg, including exploration

81.60

21270

Initiation of the management of anaesthesia for procedures involving arteries of upper leg, including bypass graft, other than a service to which another item in this Subgroup applies

163.20

21272

Initiation of the management of anaesthesia for femoral artery ligation

81.60

21274

Initiation of the management of anaesthesia for femoral artery embolectomy

122.40

21275

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the upper leg

204.00

21280

Initiation of the management of anaesthesia for microsurgical reimplantation of upper leg

306.00

Subgroup 11—Knee and popliteal area

21300

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the knee or popliteal area, or both

61.20

21321

Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of knee or popliteal area, or both

81.60

21340

Initiation of the management of anaesthesia for closed procedures on lower onethird of femur, when performed in the operating theatre of a hospital

81.60

21360

Initiation of the management of anaesthesia for open procedures on lower onethird of femur

102.00

21380

Initiation of the management of anaesthesia for closed procedures on knee joint when performed in the operating theatre of a hospital

61.20

21382

Initiation of the management of anaesthesia for arthroscopic procedures of knee joint

81.60

21390

Initiation of the management of anaesthesia for closed procedures on upper ends of tibia, fibula or patella, or any of them, when performed in the operating theatre of a hospital

61.20

21392

Initiation of the management of anaesthesia for open procedures on upper ends of tibia, fibula or patella, or any of them

81.60

21400

Initiation of the management of anaesthesia for open procedures on knee joint, other than a service to which another item in this Subgroup applies

81.60

21402

Initiation of the management of anaesthesia for knee replacement

142.80

21403

Initiation of the management of anaesthesia for bilateral knee replacement

204.00

21404

Initiation of the management of anaesthesia for disarticulation of knee

102.00

21420

Initiation of the management of anaesthesia for cast application, removal or repair, involving knee joint, undertaken in a hospital

61.20

21430

Initiation of the management of anaesthesia for procedures on veins of knee or popliteal area, other than a service to which another item in this Subgroup applies

81.60

21432

Initiation of the management of anaesthesia for repair of arteriovenous fistula of knee or popliteal area

102.00

21440

Initiation of the management of anaesthesia for procedures on arteries of knee or popliteal area, other than a service to which another item in this Subgroup applies

163.20

21445

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the knee or popliteal area

204.00

Subgroup 12—Lower leg (below knee)

21460

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of lower leg, ankle or foot

61.20

21461

Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons or fascia of lower leg, ankle or foot, other than a service to which another item in this Subgroup applies

81.60

21462

Initiation of the management of anaesthesia for all closed procedures on lower leg, ankle or foot

61.20

21464

Initiation of the management of anaesthesia for arthroscopic procedure of ankle joint

81.60

21472

Initiation of the management of anaesthesia for repair of Achilles tendon

102.00

21474

Initiation of the management of anaesthesia for gastrocnemius recession

102.00

21480

Initiation of the management of anaesthesia for open procedures on bones of lower leg, ankle or foot, including amputation, other than a service to which another item in this Subgroup applies

81.60

21482

Initiation of the management of anaesthesia for radical resection of bone involving lower leg, ankle or foot

102.00

21484

Initiation of the management of anaesthesia for osteotomy or osteoplasty of tibia or fibula

102.00

21486

Initiation of the management of anaesthesia for total ankle replacement

142.80

21490

Initiation of the management of anaesthesia for lower leg cast application, removal or repair, undertaken in a hospital

61.20

21500

Initiation of the management of anaesthesia for procedures on arteries of lower leg, including bypass graft, other than a service to which another item in this Subgroup applies

163.20

21502

Initiation of the management of anaesthesia for embolectomy of the lower leg

122.40

21520

Initiation of the management of anaesthesia for procedures on veins of lower leg, other than a service to which another item in this Subgroup applies

81.60

21522

Initiation of the management of anaesthesia for venous thrombectomy of the lower leg

102.00

21530

Initiation of the management of anaesthesia for microsurgical reimplantation of lower leg, ankle or foot

306.00

21532

Initiation of the management of anaesthesia for microsurgical reimplantation of toe

163.20

21535

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the lower leg

204.00

Subgroup 13—Shoulder and axilla

21600

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the shoulder or axilla

61.20

21610

Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of shoulder or axilla, including axillary dissection

102.00

21620

Initiation of the management of anaesthesia for closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint or shoulder joint, when performed in the operating theatre of a hospital

81.60

21622

Initiation of the management of anaesthesia for arthroscopic procedures of shoulder joint

102.00

21630

Initiation of the management of anaesthesia for open procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint or shoulder joint, other than a service to which another item in this Subgroup applies

102.00

21632

Initiation of the management of anaesthesia for radical resection involving humeral head and neck, sternoclavicular joint, acromioclavicular joint or shoulder joint

122.40

21634

Initiation of the management of anaesthesia for shoulder disarticulation

183.60

21636

Initiation of the management of anaesthesia for interthoracoscapular (forequarter) amputation

306.00

21638

Initiation of the management of anaesthesia for total shoulder replacement

204.00

21650

Initiation of the management of anaesthesia for procedures on arteries of shoulder or axilla, other than a service to which another item in this Subgroup applies

163.20

21652

Initiation of the management of anaesthesia for procedures for axillarybrachial aneurysm

204.00

21654

Initiation of the management of anaesthesia for bypass graft of arteries of shoulder or axilla

163.20

21656

Initiation of the management of anaesthesia for axillaryfemoral bypass graft

204.00

21670

Initiation of the management of anaesthesia for procedures on veins of shoulder or axilla

81.60

21680

Initiation of the management of anaesthesia for shoulder cast application, removal or repair, other than a service to which another item in this Subgroup applies, when undertaken in a hospital

61.20

21682

Initiation of the management of anaesthesia for shoulder spica application, when undertaken in a hospital

81.60

21685

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the shoulder or axilla

204.00

Subgroup 14—Upper arm and elbow

21700

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the upper arm or elbow

61.20

21710

Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of upper arm or elbow, other than a service to which another item in this Subgroup applies

81.60

21712

Initiation of the management of anaesthesia for open tenotomy of the upper arm or elbow

102.00

21714

Initiation of the management of anaesthesia for tenoplasty of the upper arm or elbow

102.00

21716

Initiation of the management of anaesthesia for tenodesis for rupture of long tendon of biceps

102.00

21730

Initiation of the management of anaesthesia for closed procedures on the upper arm or elbow, when performed in the operating theatre of a hospital

61.20

21732

Initiation of the management of anaesthesia for arthroscopic procedures of elbow joint

81.60

21740

Initiation of the management of anaesthesia for open procedures on the upper arm or elbow, other than a service to which another item in this Subgroup applies

102.00

21756

Initiation of the management of anaesthesia for radical procedures on the upper arm or elbow

122.40

21760

Initiation of the management of anaesthesia for total elbow replacement

142.80

21770

Initiation of the management of anaesthesia for procedures on arteries of upper arm, other than a service to which another item in this Subgroup applies

163.20

21772

Initiation of the management of anaesthesia for embolectomy of arteries of the upper arm

122.40

21780

Initiation of the management of anaesthesia for procedures on veins of upper arm, other than a service to which another item in this Subgroup applies

81.60

21785

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the upper arm or elbow

204.00

21790

Initiation of the management of anaesthesia for microsurgical reimplantation of upper arm

306.00

Subgroup 15—Forearm wrist and hand

21800

Initiation of the management of anaesthesia for procedures on the skin or subcutaneous tissue of the forearm, wrist or hand

61.20

21810

Initiation of the management of anaesthesia for procedures on the nerves, muscles, tendons, fascia, or bursae of the forearm, wrist or hand

81.60

21820

Initiation of the management of anaesthesia for closed procedures on the radius, ulna, wrist, or hand bones, when performed in the operating theatre of a hospital

61.20

21830

Initiation of the management of anaesthesia for open procedures on the radius, ulna, wrist, or hand bones, other than a service to which another item in this Subgroup applies

81.60

21832

Initiation of the management of anaesthesia for total wrist replacement

142.80

21834

Initiation of the management of anaesthesia for arthroscopic procedures of the wrist joint

81.60

21840

Initiation of the management of anaesthesia for procedures on the arteries of forearm, wrist or hand, other than a service to which another item in this Subgroup applies

163.20

21842

Initiation of the management of anaesthesia for embolectomy of artery of forearm, wrist or hand

122.40

21850

Initiation of the management of anaesthesia for procedures on the veins of forearm, wrist or hand, other than a service to which another item in this Subgroup applies

81.60

21860

Initiation of the management of anaesthesia for forearm, wrist, or hand cast application, removal or repair, when undertaken in a hospital

61.20

21865

Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the forearm, wrist or hand

204.00

21870

Initiation of the management of anaesthesia for microsurgical reimplantation of forearm, wrist or hand

306.00

21872

Initiation of the management of anaesthesia for microsurgical reimplantation of a finger

163.20

Subgroup 16—Anaesthesia for burns

21878

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves not more than 3% of total body surface

61.20

21879

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves more than 3% but less than 10% of total body surface

102.00

21880

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 10% or more but less than 20% of total body surface

142.80

21881

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 20% or more but less than 30% of total body surface

183.60

21882

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 30% or more but less than 40% of total body surface

224.40

21883

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 40% or more but less than 50% of total body surface

265.20

21884

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 50% or more but less than 60% of total body surface

306.00

21885

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 60% or more but less than 70% of total body surface

346.80

21886

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 70% or more but less than 80% of total body surface

387.60

21887

Initiation of the management of anaesthesia for excision or debridement of burns, with or without skin grafting, if the area of burn involves 80% or more of total body surface

428.40

Subgroup 17—Anaesthesia for radiological or other diagnostic or therapeutic procedures

21900

Initiation of the management of anaesthesia for injection procedure for hysterosalpingography

61.20

21906

Initiation of the management of anaesthesia for injection procedure for myelography—lumbar or thoracic

102.00

21908

Initiation of the management of anaesthesia for injection procedure for myelography—cervical

122.40

21910

Initiation of the management of anaesthesia for injection procedure for myelography—posterior fossa

183.60

21912

Initiation of the management of anaesthesia for injection procedure for discography—lumbar or thoracic

102.00

21914

Initiation of the management of anaesthesia for injection procedure for discography—cervical

122.40

21915

Initiation of the management of anaesthesia for peripheral arteriogram

102.00

21916

Initiation of the management of anaesthesia for arteriograms—cerebral, carotid or vertebral

102.00

21918

Initiation of the management of anaesthesia for retrograde arteriogram—brachial or femoral

102.00

21922

Initiation of the management of anaesthesia for computerised axial tomography scanning, magnetic resonance scanning or digital subtraction angiography scanning

122.40

21925

Initiation of the management of anaesthesia for retrograde cystography, retrograde urethrography or retrograde cystourethrography

81.60

21926

Initiation of the management of anaesthesia for fluoroscopy

81.60

21930

Initiation of the management of anaesthesia for bronchography

122.40

21935

Initiation of the management of anaesthesia for phlebography

102.00

21936

Initiation of the management of anaesthesia for heart—2 dimensional real time transoesophageal examination

102.00

21939

Initiation of the management of anaesthesia for peripheral venous cannulation

61.20

21941

Initiation of the management of anaesthesia for cardiac catheterisation (including coronary arteriography, ventriculography, cardiac mapping or insertion of automatic defibrillator or transvenous pacemaker)

142.80

21942

Initiation of the management of anaesthesia for cardiac electrophysiological procedures including radio frequency ablation

204.00

21943

Initiation of the management of anaesthesia for central vein catheterisation or insertion of right heart balloon catheter (via jugular, subclavian or femoral vein) by percutaneous or open exposure

102.00

21945

Initiation of the management of anaesthesia for lumbar puncture, cisternal puncture or epidural injection

102.00

21949

Initiation of the management of anaesthesia for harvesting of bone marrow for the purpose of transplantation

102.00

21952

Initiation of the management of anaesthesia for diagnostic muscle biopsy to assess for malignant hyperpyrexia

81.60

21955

Initiation of the management of anaesthesia for electroencephalography

102.00

21959

Initiation of the management of anaesthesia for brain stem evoked response audiometry

102.00

21962

Initiation of the management of anaesthesia for electrocochleography by extratympanic method or transtympanic membrane insertion method

102.00

21965

Initiation of the management of anaesthesia as a therapeutic procedure if there is a clinical need for anaesthesia, not for headache of any etiology

102.00

21969

Initiation of the management of anaesthesia during hyperbaric therapy, if the medical practitioner is not confined in the chamber (including the administration of oxygen)

163.20

21970

Initiation of the management of anaesthesia during hyperbaric therapy, if the medical practitioner is confined in the chamber (including the administration of oxygen)

306.00

21973

Initiation of the management of anaesthesia for brachytherapy using radioactive sealed sources

102.00

21976

Initiation of the management of anaesthesia for therapeutic nuclear medicine

102.00

21980

Initiation of the management of anaesthesia for radiotherapy

102.00

Subgroup 18—Miscellaneous

21990

Initiation of the management of anaesthesia, being a service to which another item in this Subgroup or in Subgroups 1 to 17 or 20 would have applied if the procedure in connection with which the service is provided had not been discontinued

61.20

21992

Initiation of the management of anaesthesia performed on a person under the age of 10 years in connection with a procedure covered by an item that does not include the word “(Anaes.)”

81.60

21997

Initiation of the management of anaesthesia in connection with a procedure covered by an item that does not include the word “(Anaes.)”, other than a service to which item 21965 or 21992 applies, if there is a clinical need for anaesthesia

81.60

Subgroup 19—Therapeutic and diagnostic services performed in connection with the management of anaesthesia

22002

Administration of homologous blood or bone marrow already collected, when performed in association with the management of anaesthesia

81.60

22007

Endotracheal intubation with flexible fibreoptic scope associated with difficult airway, when performed in association with the management of anaesthesia

81.60

22008

Double lumen endobronchial tube or bronchial blocker, insertion of, when performed in association with the management of anaesthesia

81.60

22012

Monitoring that:

(a) is of one of the following types of blood pressure:

(i) central venous blood pressure;

(ii) pulmonary arterial blood pressure;

(iii) systemic arterial blood pressure;

(iv) cardiac intracavity blood pressure; and

(b) is conducted by indwelling catheter; and

(c) is performed in association with the administration of anaesthesia for a procedure and not as a service to which item 13876 applies; and

(d) is performed, on a day, on a patient who:

(i) is categorised as having a high risk of complications; or

(ii) during the procedure develops either complications or a high risk of complications; and

(e) has not previously been performed in those circumstances on the day on the patient for that type of blood pressure

61.20

22014

Monitoring that:

(a) is of one of the following types of blood pressure:

(i) central venous blood pressure;

(ii) pulmonary arterial blood pressure;

(iii) systemic arterial blood pressure;

(iv) cardiac intracavity blood pressure; and

(b) is conducted by indwelling catheter; and

(c) is performed in association with the administration of anaesthesia for a procedure (the current procedure) and not as a service to which item 13876 applies; and

(d) is performed, on a day, on a patient:

(i) who is categorised as having a high risk of complications or develops during the current procedure either complications or a high risk of complications; and

(ii) for whom monitoring of that type of blood pressure to which item 22012 applies has already been performed on the day in association with the administration of anaesthesia for another discrete procedure; and

(e) has not previously been performed in association with the current procedure for that type of blood pressure

61.20

22015

Right heart balloon catheter, insertion of, including pulmonary wedge pressure and cardiac output measurement, when performed in association with the management of anaesthesia

122.40

22020

Central vein catheterisation by percutaneous or open exposure, other than a service to which item 13318 applies, when performed in association with the management of anaesthesia

81.60

22025

Intraarterial cannulation when performed in association with the management of anaesthesia for a procedure for a patient who:

(a) is categorised as having a high risk of complications; or

(b) develops a high risk of complications during the procedure

81.60

22031

Intrathecal or epidural injection (initial) of a therapeutic substance, with or without insertion of a catheter, in association with anaesthesia and surgery, for postoperative pain management, other than a service associated with a service to which item 22036 applies

102.00

22036

Intrathecal or epidural injection (subsequent) of a therapeutic substance, using an insitu catheter, in association with anaesthesia and surgery, for postoperative pain, other than a service associated with a service to which item 22031 applies

61.20

22041

Introduction of a plexus or nerve block proximal to the lower leg or forearm, perioperatively performed in the induction room, theatre or recovery room, for postoperative pain management

40.80

22042

Introduction of a regional or field nerve block performed via retrobulbar, peribulbar or subTenon’s block injection of an anaesthetic agent, or other complex eye block, when administered by an anaesthetist perioperatively

20.40

22051

Intraoperative transoesophageal echocardiography—monitoring in real time the structure and function of the heart chambers, valves and surrounding structures, including assessment of blood flow, with appropriate permanent recording during procedures on the heart, pericardium or great vessels of the chest, other than a service associated with a service to which item 55130, 55135 or 21936 applies

183.60

22055

Perfusion of limb or organ using heartlung machine or equivalent, other than a service associated with anaesthesia to which an item in Subgroup 21 applies

244.80

22060

Whole body perfusion, cardiac bypass, if the heartlung machine or equivalent is continuously operated by a medical perfusionist, other than a service associated with anaesthesia to which an item in Subgroup 21 applies

408.00

22065

Induced controlled hypothermia—total body, that is:

(a) a service to which item 22060 applies; and

(b) not a service associated with anaesthesia, to which an item in Subgroup 21 applies

102.00

22075

Deep hypothermic circulatory arrest, with core temperature less than 22°c, including management of retrograde cerebral perfusion (if performed), other than a service associated with anaesthesia to which an item in Subgroup 21 applies

306.00

Subgroup 20—Management of anaesthesia in connection with a dental service

22900

Initiation of the management by a medical practitioner of anaesthesia for extraction of tooth or teeth, with or without incision of soft tissue or removal of bone

122.40

22905

Initiation of the management of anaesthesia for restorative dental work

122.40

Subgroup 21—Anaesthesia, perfusion and assistance at anaesthesia (time component)

23010

Anaesthesia, perfusion or assistance, if the service time is not more than 15 minutes

20.40

23025

Anaesthesia, perfusion or assistance, if the service time is more than 15 minutes but not more than 30 minutes

40.80

23035

Anaesthesia, perfusion or assistance, if the service time is more than 30 minutes but not more than 45 minutes

61.20

23045

Anaesthesia, perfusion or assistance, if the service time is more than 45 minutes but not more than 1 hour

81.60

23055

Anaesthesia, perfusion or assistance, if the service time is more than 1 hour but not more than 1:15 hours

102.00

23065

Anaesthesia, perfusion or assistance, if the service time is more than 1:15 hours but not more than 1:30 hours

122.40

23075

Anaesthesia, perfusion or assistance, if the service time is more than 1:30 hours but not more than 1:45 hours

142.80

23085

Anaesthesia, perfusion or assistance, if the service time is more than 1:45 hours but not more than 2:00 hours

163.20

23091

Anaesthesia, perfusion or assistance, if the service time is more than 2:00 hours but not more than 2:10 hours

183.60

23101

Anaesthesia, perfusion or assistance, if the service time is more than 2:10 hours but not more than 2:20 hours

204.00

23111

Anaesthesia, perfusion or assistance, if the service time is more than 2:20 hours but not more than 2:30 hours

224.40

23112

Anaesthesia, perfusion or assistance, if the service time is more than 2:30 hours but not more than 2:40 hours

244.80

23113

Anaesthesia, perfusion or assistance, if the service time is more than 2:40 hours but not more than 2:50 hours

265.20

23114

Anaesthesia, perfusion or assistance, if the service time is more than 2:50 hours but not more than 3:00 hours

285.60

23115

Anaesthesia, perfusion or assistance, if the service time is more than 3:00 hours but not more than 3:10 hours

306.00

23116

Anaesthesia, perfusion or assistance, if the service time is more than 3:10 hours but not more than 3:20 hours

326.40

23117

Anaesthesia, perfusion or assistance, if the service time is more than 3:20 hours but not more than 3:30 hours

346.80

23118

Anaesthesia, perfusion or assistance, if the service time is more than 3:30 hours but not more than 3:40 hours

367.20

23119

Anaesthesia, perfusion or assistance, if the service time is more than 3:40 hours but not more than 3:50 hours

387.60

23121

Anaesthesia, perfusion or assistance, if the service time is more than 3:50 hours but not more than 4:00 hours

408.00

23170

Anaesthesia, perfusion or assistance, if the service time is more than 4:00 hours but not more than 4:10 hours

428.40

23180

Anaesthesia, perfusion or assistance, if the service time is more than 4:10 hours but not more than 4:20 hours

448.80

23190

Anaesthesia, perfusion or assistance, if the service time is more than 4:20 hours but not more than 4:30 hours

469.20

23200

Anaesthesia, perfusion or assistance, if the service time is more than 4:30 hours but not more than 4:40 hours

489.60

23210

Anaesthesia, perfusion or assistance, if the service time is more than 4:40 hours but not more than 4:50 hours

510.00

23220

Anaesthesia, perfusion or assistance, if the service time is more than 4:50 hours but not more than 5:00 hours

530.40

23230

Anaesthesia, perfusion or assistance, if the service time is more than 5:00 hours but not more than 5:10 hours

550.80

23240

Anaesthesia, perfusion or assistance, if the service time is more than 5:10 hours but not more than 5:20 hours

571.20

23250

Anaesthesia, perfusion or assistance, if the service time is more than 5:20 hours but not more than 5:30 hours

591.60

23260

Anaesthesia, perfusion or assistance, if the service time is more than 5:30 hours but not more than 5:40 hours

612.00

23270

Anaesthesia, perfusion or assistance, if the service time is more than 5:40 hours but not more than 5:50 hours

632.40

23280

Anaesthesia, perfusion or assistance, if the service time is more than 5:50 hours but not more than 6:00 hours

652.80

23290

Anaesthesia, perfusion or assistance, if the service time is more than 6:00 hours but not more than 6:10 hours

673.20

23300

Anaesthesia, perfusion or assistance, if the service time is more than 6:10 hours but not more than 6:20 hours

693.60

23310

Anaesthesia, perfusion or assistance, if the service time is more than 6:20 hours but not more than 6:30 hours

714.00

23320

Anaesthesia, perfusion or assistance, if the service time is more than 6:30 hours but not more than 6:40 hours

734.40

23330

Anaesthesia, perfusion or assistance, if the service time is more than 6:40 hours but not more than 6:50 hours

754.80

23340

Anaesthesia, perfusion or assistance, if the service time is more than 6:50 hours but not more than 7:00 hours

775.20

23350

Anaesthesia, perfusion or assistance, if the service time is more than 7:00 hours but not more than 7:10 hours

795.60

23360

Anaesthesia, perfusion or assistance, if the service time is more than 7:10 hours but not more than 7:20 hours

816.00

23370

Anaesthesia, perfusion or assistance, if the service time is more than 7:20 hours but not more than 7:30 hours

836.40

23380

Anaesthesia, perfusion or assistance, if the service time is more than 7:30 hours but not more than 7:40 hours

856.80

23390

Anaesthesia, perfusion or assistance, if the service time is more than 7:40 hours but not more than 7:50 hours

877.20

23400

Anaesthesia, perfusion or assistance, if the service time is more than 7:50 hours but not more than 8:00 hours

897.60

23410

Anaesthesia, perfusion or assistance, if the service time is more than 8:00 hours but not more than 8:10 hours

918.00

23420

Anaesthesia, perfusion or assistance, if the service time is more than 8:10 hours but not more than 8:20 hours

938.40

23430

Anaesthesia, perfusion or assistance, if the service time is more than 8:20 hours but not more than 8:30 hours

958.80

23440

Anaesthesia, perfusion or assistance, if the service time is more than 8:30 hours but not more than 8:40 hours

979.20

23450

Anaesthesia, perfusion or assistance, if the service time is more than 8:40 hours but not more than 8:50 hours

999.60

23460

Anaesthesia, perfusion or assistance, if the service time is more than 8:50 hours but not more than 9:00 hours

1,020.00

23470

Anaesthesia, perfusion or assistance, if the service time is more than 9:00 hours but not more than 9:10 hours

1,040.40

23480

Anaesthesia, perfusion or assistance, if the service time is more than 9:10 hours but not more than 9:20 hours

1,060.80

23490

Anaesthesia, perfusion or assistance, if the service time is more than 9:20 hours but not more than 9:30 hours

1,081.20

23500

Anaesthesia, perfusion or assistance, if the service time is more than 9:30 hours but not more than 9:40 hours

1,101.60

23510

Anaesthesia, perfusion or assistance, if the service time is more than 9:40 hours but not more than 9:50 hours

1,122.00

23520

Anaesthesia, perfusion or assistance, if the service time is more than 9:50 hours but not more than 10:00 hours

1,142.40

23530

Anaesthesia, perfusion or assistance, if the service time is more than 10:00 hours but not more than 10:10 hours

1,162.80

23540

Anaesthesia, perfusion or assistance, if the service time is more than 10:10 hours but not more than 10:20 hours

1,183.20

23550

Anaesthesia, perfusion or assistance, if the service time is more than 10:20 hours but not more than 10:30 hours

1,203.60

23560

Anaesthesia, perfusion or assistance, if the service time is more than 10:30 hours but not more than 10:40 hours

1,224.00

23570

Anaesthesia, perfusion or assistance, if the service time is more than 10:40 hours but not more than 10:50 hours

1,244.40

23580

Anaesthesia, perfusion or assistance, if the service time is more than 10:50 hours but not more than 11:00 hours

1,264.80

23590

Anaesthesia, perfusion or assistance, if the service time is more than 11:00 hours but not more than 11:10 hours

1,285.20

23600

Anaesthesia, perfusion or assistance, if the service time is more than 11:10 hours but not more than 11:20 hours

1,305.60

23610

Anaesthesia, perfusion or assistance, if the service time is more than 11:20 hours but not more than 11:30 hours

1,326.00

23620

Anaesthesia, perfusion or assistance, if the service time is more than 11:30 hours but not more than 11:40 hours

1,346.40

23630

Anaesthesia, perfusion or assistance, if the service time is more than 11:40 hours but not more than 11:50 hours

1,366.80

23640

Anaesthesia, perfusion or assistance, if the service time is more than 11:50 hours but not more than 12:00 hours

1,387.20

23650

Anaesthesia, perfusion or assistance, if the service time is more than 12:00 hours but not more than 12:10 hours

1,407.60

23660

Anaesthesia, perfusion or assistance, if the service time is more than 12:10 hours but not more than 12:20 hours

1,428.00

23670

Anaesthesia, perfusion or assistance, if the service time is more than 12:20 hours but not more than 12:30 hours

1,448.40

23680

Anaesthesia, perfusion or assistance, if the service time is more than 12:30 hours but not more than 12:40 hours

1,468.80

23690

Anaesthesia, perfusion or assistance, if the service time is more than 12:40 hours but not more than 12:50 hours

1,489.20

23700

Anaesthesia, perfusion or assistance, if the service time is more than 12:50 hours but not more than 13:00 hours

1,509.60

23710

Anaesthesia, perfusion or assistance, if the service time is more than 13:00 hours but not more than 13:10 hours

1,530.00

23720

Anaesthesia, perfusion or assistance, if the service time is more than 13:10 hours but not more than 13:20 hours

1,550.40

23730

Anaesthesia, perfusion or assistance, if the service time is more than 13:20 hours but not more than 13:30 hours

1,570.80

23740

Anaesthesia, perfusion or assistance, if the service time is more than 13:30 hours but not more than 13:40 hours

1,591.20

23750

Anaesthesia, perfusion or assistance, if the service time is more than 13:40 hours but not more than 13:50 hours

1,611.60

23760

Anaesthesia, perfusion or assistance, if the service time is more than 13:50 hours but not more than 14:00 hours

1,632.00

23770

Anaesthesia, perfusion or assistance, if the service time is more than 14:00 hours but not more than 14:10 hours

1,652.40

23780

Anaesthesia, perfusion or assistance, if the service time is more than 14:10 hours but not more than 14:20 hours

1,672.80

23790

Anaesthesia, perfusion or assistance, if the service time is more than 14:20 hours but not more than 14:30 hours

1,693.20

23800

Anaesthesia, perfusion or assistance, if the service time is more than 14:30 hours but not more than 14:40 hours

1,713.60

23810

Anaesthesia, perfusion or assistance, if the service time is more than 14:40 hours but not more than 14:50 hours

1,734.00

23820

Anaesthesia, perfusion or assistance, if the service time is more than 14:50 hours but not more than 15:00 hours

1,754.40

23830

Anaesthesia, perfusion or assistance, if the service time is more than 15:00 hours but not more than 15:10 hours

1,774.80

23840

Anaesthesia, perfusion or assistance, if the service time is more than 15:10 hours but not more than 15:20 hours

1,795.20

23850

Anaesthesia, perfusion or assistance, if the service time is more than 15:20 hours but not more than 15:30 hours

1,815.60

23860

Anaesthesia, perfusion or assistance, if the service time is more than 15:30 hours but not more than 15:40 hours

1,836.00

23870

Anaesthesia, perfusion or assistance, if the service time is more than15:40 hours but not more than 15:50 hours

1,856.40

23880

Anaesthesia, perfusion or assistance, if the service time is more than 15:50 hours but not more than 16:00 hours

1,876.80

23890

Anaesthesia, perfusion or assistance, if the service time is more than 16:00 hours but not more than 16:10 hours

1,897.20

23900

Anaesthesia, perfusion or assistance, if the service time is more than 16:10 hours but not more than 16:20 hours

1,917.60

23910

Anaesthesia, perfusion or assistance, if the service time is more than 16:20 hours but not more than 16:30 hours

1,938.00

23920

Anaesthesia, perfusion or assistance, if the service time is more than 16:30 hours but not more than 16:40 hours

1,958.40

23930

Anaesthesia, perfusion or assistance, if the service time is more than 16:40 hours but not more than 16:50 hours

1,978.80

23940

Anaesthesia, perfusion or assistance, if the service time is more than 16:50 hours but not more than 17:00 hours

1,999.20

23950

Anaesthesia, perfusion or assistance, if the service time is more than 17:00 hours but not more than 17:10 hours

2,019.60

23960

Anaesthesia, perfusion or assistance, if the service time is more than 17:10 hours but not more than 17:20 hours

2,040.00

23970

Anaesthesia, perfusion or assistance, if the service time is more than 17:20 hours but not more than 17:30 hours

2,060.40

23980

Anaesthesia, perfusion or assistance, if the service time is more than 17:30 hours but not more than 17:40 hours

2,080.80

23990

Anaesthesia, perfusion or assistance, if the service time is more than 17:40 hours but not more than 17:50 hours

2,101.20

24100

Anaesthesia, perfusion or assistance, if the service time is more than 17:50 hours but not more than 18:00 hours

2,121.60

24101

Anaesthesia, perfusion or assistance, if the service time is more than 18:00 hours but not more than 18:10 hours

2,142.00

24102

Anaesthesia, perfusion or assistance, if the service time is more than 18:10 hours but not more than 18:20 hours

2,162.40

24103

Anaesthesia, perfusion or assistance, if the service time is more than 18:20 hours but not more than 18:30 hours

2,182.80

24104

Anaesthesia, perfusion or assistance, if the service time is more than 18:30 hours but not more than 18:40 hours

2,203.20

24105

Anaesthesia, perfusion or assistance, if the service time is more than 18:40 hours but not more than 18:50 hours

2,223.60

24106

Anaesthesia, perfusion or assistance, if the service time is more than 18:50 hours but not more than 19:00 hours

2,244.00

24107

Anaesthesia, perfusion or assistance, if the service time is more than 19:00 hours but not more than 19:10 hours

2,264.40

24108

Anaesthesia, perfusion or assistance, if the service time is more than 19:10 hours but not more than 19:20 hours

2,284.80

24109

Anaesthesia, perfusion or assistance, if the service time is more than 19:20 hours but not more than 19:30 hours

2,305.20

24110

Anaesthesia, perfusion or assistance, if the service time is more than 19:30 hours but not more than 19:40 hours

2,325.60

24111

Anaesthesia, perfusion or assistance, if the service time is more than 19:40 hours but not more than 19:50 hours

2,346.00

24112

Anaesthesia, perfusion or assistance, if the service time is more than 19:50 hours but not more than 20:00 hours

2,366.40

24113

Anaesthesia, perfusion or assistance, if the service time is more than 20:00 hours but not more than 20:10 hours

2,386.80

24114

Anaesthesia, perfusion or assistance, if the service time is more than 20:10 hours but not more than 20:20 hours

2,407.20

24115

Anaesthesia, perfusion or assistance, if the service time is more than 20:20 hours but not more than 20:30 hours

2,427.60

24116

Anaesthesia, perfusion or assistance, if the service time is more than 20:30 hours but not more than 20:40 hours

2,448.00

24117

Anaesthesia, perfusion or assistance, if the service time is more than 20:40 hours but not more than 20:50 hours

2,468.40

24118

Anaesthesia, perfusion or assistance, if the service time is more than 20:50 hours but not more than 21:00 hours

2,488.80

24119

Anaesthesia, perfusion or assistance, if the service time is more than 21:00 hours but not more than 21:10 hours

2,509.20

24120

Anaesthesia, perfusion or assistance, if the service time is more than 21:10 hours but not more than 21:20 hours

2,529.60

24121

Anaesthesia, perfusion or assistance, if the service time is more than 21:20 hours but not more than 21:30 hours

2,550.00

24122

Anaesthesia, perfusion or assistance, if the service time is more than 21:30 hours but not more than 21:40 hours

2,570.40

24123

Anaesthesia, perfusion or assistance, if the service time is more than 21:40 hours but not more than 21:50 hours

2,590.80

24124

Anaesthesia, perfusion or assistance, if the service time is more than 21:50 hours but not more than 22:00 hours

2,611.20

24125

Anaesthesia, perfusion or assistance, if the service time is more than 22:00 hours but not more than 22:10 hours

2,631.60

24126

Anaesthesia, perfusion or assistance, if the service time is more than 22:10 hours but not more than 22:20 hours

2,652.00

24127

Anaesthesia, perfusion or assistance, if the service time is more than 22:20 hours but not more than 22:30 hours

2,672.40

24128

Anaesthesia, perfusion or assistance, if the service time is more than 22:30 hours but not more than 22:40 hours

2,692.80

24129

Anaesthesia, perfusion or assistance, if the service time is more than 22:40 hours but not more than 22:50 hours

2,713.20

24130

Anaesthesia, perfusion or assistance, if the service time is more than 22:50 hours but not more than 23:00 hours

2,733.60

24131

Anaesthesia, perfusion or assistance, if the service time is more than 23:00 hours but not more than 23:10 hours

2,754.00

24132

Anaesthesia, perfusion or assistance, if the service time is more than 23:10 hours but not more than 23:20 hours

2,774.40

24133

Anaesthesia, perfusion or assistance, if the service time is more than 23:20 hours but not more than 23:30 hours

2,794.80

24134

Anaesthesia, perfusion or assistance, if the service time is more than 23:30 hours but not more than 23:40 hours

2,815.20

24135

Anaesthesia, perfusion or assistance, if the service time is more than 23:40 hours but not more than 23:50 hours

2,835.60

24136

Anaesthesia, perfusion or assistance, if the service time is more than 23:50 hours but not more than 24:00 hours

2,856.00

Subgroup 22—Anaesthesia, perfusion and assistance at anaesthesia (modifying components—physical status)

25000

Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient has severe systemic disease (equivalent to ASA physical status indicator 3)

20.40

25005

Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient has severe systemic disease which is a constant threat to life (equivalent to ASA physical status indicator 4)

40.80

25010

Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient is not expected to survive for 24 hours, with or without the associated operation (equivalent to ASA physical status indicator 5)

61.20

Subgroup 23—Anaesthesia, perfusion and assistance at anaesthesia (modifying components—other)

25013

Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient is aged under 4 years

20.40

25014

Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient is aged 75 years or more

20.40

25020

Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient requires immediate treatment without which there would be significant threat to life or body part—other than a service associated with a service to which item 25025, 25030 or 25050 applies

40.80

Subgroup 24—Anaesthesia and assistance at anaesthesia (after hours emergency modifier)

25025

Anaesthesia, if the patient requires immediate treatment without which there would be significant threat to life or body part and if more than 50% of the service time occurs between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday

Amount under clause 5.9.1

25030

Assistance in the management of anaesthesia, if the patient requires immediate treatment without which there would be significant threat to life or body part and if more than 50% of the service time occurs between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday

Amount under clause 5.9.1

Subgroup 25—Perfusion (after hours emergency modifier)

25050

Perfusion, if the patient requires immediate treatment without which there would be significant threat to life or body part and if more than 50% of the service time occurs between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday

Amount under clause 5.9.1

Subgroup 26—Assistance at anaesthesia

25200

Assistance in the management of anaesthesia requiring continuous anaesthesia on a patient in imminent danger of death requiring continuous life saving emergency treatment, to the exclusion of attendance on all other patients

Amount under clause 5.9.2

25205

Assistance in the management of elective anaesthesia, if:

(a) the patient has complex airway problems; or

(b) the patient is a neonate; or

(c) the patient is a paediatric patient and is receiving one or more of the following services:

(i) invasive monitoring, either intravascular or transoesophageal;

(ii) organ transplantation;

(iii) craniofacial surgery;

(iv) major tumour resection;

(v) separation of conjoint twins; or

(d) there is anticipated to be massive blood loss (greater than 50% of blood volume) during the procedure; or

(e) the patient is critically ill, with multiple organ failure; or

(f) the service time of the management of anaesthesia exceeds 6 hours and the assistance is provided to the exclusion of attendance on all other patients

Amount under clause 5.9.2

 

Division 5.10Group T8: Surgical operations

Subdivision ASubgroup 1 of Group T8

5.10.1  Meaning of amount under clause 5.10.1

  In item 30001:

amount under clause 5.10.1 means 50% of the fee that would normally apply for a surgical procedure if the surgical procedure had not been discontinued before completion.

5.10.2  Meaning of amount under clause 5.10.2

  In item 31340:

amount under clause 5.10.2, for the excision of muscle, bone or cartilage in association with the excision of a malignant tumour of skin under another item, means 75% of the fee payable under that other item.

5.10.3  Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures

  For the purposes of items 30196 to 30202, the requirement for histopathological proof of malignancy is satisfied if:

 (a) multiple lesions are removed from a single anatomical region; and

 (b) a single lesion from that region is histologically tested and proven positive for malignancy.

5.10.4  Restrictions on items 30299 and 30300—patients

  A service described in item 30299 or 30300 applies only if preoperative lymphoscintigraphy is used because the patient is allergic to lymphotrophic dye.

5.10.5  Items 30440, 30451, 30492 and 30495 do not include imaging

  A service described in item 30440, 30451, 30492 or 30495 does not include imaging.

Note: The imaging services associated with these services are described in the diagnostic imaging services table.

5.10.6  Restrictions on items 30688, 30690, 30692 and 30694—patient notes

  Item 30688, 30690, 30692 or 30694 applies to a service only if the provider makes a record of the findings of the ultrasound imaging in the patient’s notes.

5.10.7  Application of item 35412

 (1) Intraoperative imaging is taken to be part of the service associated with the coiling of an aneurysm and cannot be charged in addition to item 35412.

 (2) Preoperative diagnostic imaging, including aftercare, under item 60009, 60010, 60072, 60073, 60075, 60076, 60078 or 60079 of the diagnostic imaging services table may be separately claimed.

5.10.8  Restrictions on items 31569, 31572, 31575, 31578, 31581, 31587 and 31590—services provided on same occasion

 (1) A service described in item 31569, 31572, 31575, 31578, 31581, 31587 or 31590 may only be claimed once for a patient for the same occasion.

 (2) If 2 or more services described in item 31569, 31572, 31575, 31578, 31581, 31587 or 31590 are performed in conjunction on a patient on the same occasion, only one of the services may be claimed for the patient for the occasion.

5.10.9  Items in Subgroup 1 of Group T8

  This clause sets out items in Subgroup 1 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—General

30001

Operative procedure, being a service to which an item in this Group would have applied had the procedure not been discontinued on medical grounds

Amount under clause 5.10.1

30003

Localised burns, dressing of, (not involving grafting)—each attendance at which the procedure is performed, including any associated consultation

37.45

30006

Extensive burns, dressing of, without anaesthesia (not involving grafting)—each attendance at which the procedure is performed, including any associated consultation

47.95

30010

Localised burns, dressing of, under general anaesthesia (not involving grafting) (H) (Anaes.)

76.25

30014

Extensive burns, dressing of, under general anaesthesia (not involving grafting) (H) (Anaes.)

160.25

30017

Burns, excision of, under general anaesthesia, involving not more than 10% of body surface, if grafting is not carried out during the same operation (Anaes.) (Assist.)

336.20

30020

Burns, excision of, under general anaesthesia, involving more than 10% of body surface, if grafting is not carried out during the same operation (H) (Anaes.) (Assist.)

654.85

30023

Wound of soft tissue, traumatic, deep or extensively contaminated, debridement of, under general anaesthesia, or regional or field nerve block, including suturing of the wound if carried out (Anaes.) (Assist.)

336.20

30024

Wound of soft tissue, debridement of an extensively infected postsurgical incision or Fournier’s gangrene, under general anaesthesia, or regional or field nerve block, including suturing of the wound if carried out (Anaes.) (Assist.)

336.20

30026

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, not on face or neck, small (not more than 7 cm long), superficial, other than a service to which another item in Group T4 applies (Anaes.)

53.85

30029

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, not on face or neck, small (not more than 7 cm in length), involving deeper tissue, other than a service to which another item in Group T4 applies (Anaes.)

92.80

30032

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, on face or neck, small (not more than 7 cm long), superficial (Anaes.)

85.05

30035

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, on face or neck, small (not more than 7 cm long), involving deeper tissue (Anaes.)

121.25

30038

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, not on face or neck, large (more than 7 cm long), superficial, other than a service to which another item in Group T4 applies (Anaes.)

92.80

30042

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, other than on face or neck, large (more than 7 cm long), involving deeper tissue, other than a service to which another item in Group T4 applies (Anaes.)

191.40

30045

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, on face or neck, large (more than 7 cm long), superficial (Anaes.)

121.25

30049

Skin and subcutaneous tissue or mucous membrane, repair of wound of, other than wound closure at time of surgery, on face or neck, large (more than 7 cm long), involving deeper tissue (Anaes.)

191.40

30052

Full thickness laceration of ear, eyelid, nose or lip, repair of, with accurate apposition of each layer of tissue (Anaes.) (Assist.)

261.90

30055

Wounds, dressing of, under general anaesthesia, with or without removal of sutures, other than a service associated with a service to which another item in this Group applies (Anaes.)

76.25

30058

Postoperative haemorrhage, control of, under general anaesthesia, as an independent procedure (Anaes.)

148.85

30061

Superficial foreign body, removal of, (including from cornea or sclera) as an independent procedure (Anaes.)

24.25

30062

Etonogestrel subcutaneous implant, removal of, as an independent procedure (Anaes.)

62.65

30064

Subcutaneous foreign body, removal of, requiring incision and exploration, including closure of wound if performed, as an independent procedure (Anaes.)

113.30

30068

Foreign body in muscle, tendon or other deep tissue, removal of, as an independent procedure (Anaes.) (Assist.)

285.45

30071

Diagnostic biopsy of skin, as an independent procedure, if the biopsy specimen is sent for pathological examination (Anaes.)

53.85

30072

Diagnostic biopsy of mucous membrane, as an independent procedure, if the biopsy specimen is sent for pathological examination (Anaes.)

53.85

30075

Diagnostic biopsy of lymph node, muscle or other deep tissue or organ, as an independent procedure, if the biopsy specimen is sent for pathological examination (Anaes.)

154.45

30078

Diagnostic drill biopsy of lymph node, deep tissue or organ, as an independent procedure, if the biopsy specimen is sent for pathological examination (Anaes.)

50.00

30081

Diagnostic biopsy of bone marrow by trephine using an open approach, if the biopsy specimen is sent for pathological examination (Anaes.)

113.30

30084

Diagnostic biopsy of bone marrow by trephine using a percutaneous approach, if the biopsy specimen is sent for pathological examination (Anaes.)

60.65

30087

Diagnostic biopsy of bone marrow by aspiration or punch biopsy of synovial membrane, if the biopsy specimen is sent for pathological examination (Anaes.)

30.35

30090

Diagnostic biopsy of pleura, percutaneous, if the biopsy specimen is sent for pathological examination—one or more biopsies on any one occasion (Anaes.)

132.55

30093

Diagnostic needle biopsy of vertebra, if the biopsy specimen is sent for pathological examination (Anaes.)

176.90

30094

Diagnostic percutaneous aspiration biopsy of deep organ using interventional techniques (but not including imaging) if the biopsy specimen is sent for pathological examination (Anaes.)

195.35

30096

Diagnostic scalene node biopsy, by open procedure, if the specimen excised is sent for pathological examination (Anaes.)

189.65

30097

Personal performance of a Synacthen Stimulation Test, including associated consultation, by a medical practitioner with resuscitation training and access to facilities where life support procedures can be implemented, if:

(a) serum cortisol at 8.30 am to 9.30 am on any day in the preceding month has been measured at greater than 100 nmol/L but less than 400 nmol/L; or

(b) the patient is acutely unwell and adrenal insufficiency is suspected

100.20

30099

Sinus, excision of, involving superficial tissue only (Anaes.)

92.80

30103

Sinus, excision of, involving muscle and deep tissue (Anaes.)

189.65

30104

Preauricular sinus, excision of, on a person 10 years of age or over (Anaes.)

130.90

30105

Preauricular sinus, excision of, on a person under 10 years of age (Anaes.)

170.10

30107

Ganglion or small bursa, excision of, other than a service associated with a service to which another item in this Group applies (Anaes.)

226.80

30111

Bursa (large), including olecranon, calcaneum or patella, excision of (Anaes.) (Assist.)

383.10

30114

Bursa, semimembranosus (Baker’s cyst), excision of (H) (Anaes.) (Assist.)

383.10

30165

Lipectomy, wedge excision of abdominal apron that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and

(b) the abdominal apron interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H) (Anaes.) (Assist.)

469.10

30168

Lipectomy, wedge excision of redundant nonabdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves one excision only

(H) (Anaes.) (Assist.)

469.10

30171

Lipectomy, wedge excision of redundant nonabdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 2 excisions only

(H) (Anaes.) (Assist.)

713.35

30172

Lipectomy, wedge excision of redundant nonabdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 3 or more excisions

(H) (Anaes.) (Assist.)

713.35

30176

Lipectomy, radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30177, 30179, 45530, 45564 or 45565 applies, if the patient has previously had a massive intraabdominal or pelvic tumour surgically removed

(H) (Anaes.) (Assist.)

1,016.45

30177

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H) (Anaes.) (Assist.)

1,016.45

30179

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar), not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if:

(a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and

(b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H) (Anaes.) (Assist.)

1,251.05

30180

Axillary hyperhidrosis, partial excision for (Anaes.)

140.80

30183

Axillary hyperhidrosis, total excision of sweat gland bearing area (Anaes.)

254.20

30187

Palmar or plantar warts, removal of, by carbon dioxide laser or erbium laser, requiring admission to a hospital, or when performed by a specialist in the practice of the specialist’s specialty (5 or more warts) (Anaes.)

264.95

30189

Warts or molluscum contagiosum (one or more), removal of, by any method (other than by chemical means), if undertaken in the operating theatre of a hospital, other than a service associated with a service to which another item in this Group applies (Anaes.)

151.90

30190

Angiofibromas, trichoepitheliomas or other severely disfiguring tumours of the face or neck (excluding melanocytic naevi, sebaceous hyperplasia, dermatosis papulosa nigra, Campbell De Morgan angiomas and seborrheic or viral warts), suitable for laser ablation as confirmed by the opinion of a specialist in the specialty of dermatology—removal of, by carbon dioxide laser or erbium laser ablation, including associated resurfacing (10 or more tumours) (Anaes.)

410.15

30191

Angiofibromas, trichoepithelioma, epidermal naevi, xanthelasma, pyogenic granuloma, genital angiokeratomas, hereditary haemorrhagic telangiectasia and other severely disfiguring or recurrently bleeding tumours (excluding melanocytic naevi, sebaceous hyperplasia, dermatosis papulosa nigra, Campbell De Morgan angiomas and seborrheic or viral warts), treatment of, with carbon dioxide/erbium or other appropriate laser (or curettage and fine point diathermy for pyogenic granuloma only), if confirmed by the opinion of a specialist in the specialty of dermatology, one or more lesions

65.45

30192

Premalignant skin lesions (including solar keratoses), treatment of, by ablative technique (10 or more lesions) (Anaes.)

40.80

30196

Malignant neoplasm of skin or mucous membrane that has been:

(a) proven by histopathology; or

(b) confirmed by the opinion of a specialist in the specialty of dermatology where a specimen has been submitted for histologic confirmation;

removal of, by serial curettage, or carbon dioxide laser or erbium laser excisionablation, including any associated cryotherapy or diathermy (Anaes.)

130.20

30202

Malignant neoplasm of skin or mucous membrane proven by histopathology or confirmed by the opinion of a specialist in the specialty of dermatology—removal of, by liquid nitrogen cryotherapy using repeat freezethaw cycles

49.85

30207

Skin lesions, multiple injections with glucocorticoid preparations (Anaes.)

46.00

30210

Keloid and other skin lesions, extensive, multiple injections of glucocorticoid preparations, if undertaken in the operating theatre of a hospital on a patient less than 16 years of age (H) (Anaes.)

168.05

30216

Haematoma, aspiration of (Anaes.)

28.20

30219

Haematoma, furuncle, small abscess or similar lesion not requiring admission to a hospital, incision with drainage of, excluding aftercare

28.20

30223

Large haematoma, large abscess, carbuncle, cellulitis or similar lesion, incision with drainage of, excluding aftercare (H) (Anaes.)

168.05

30224

Percutaneous drainage of deep abscess using interventional techniques—but not including imaging (Anaes.)

245.00

30225

Abscess drainage tube, exchange of using interventional techniques—but not including imaging (Anaes.)

276.05

30226

Muscle, excision of (limited) or fasciotomy (Anaes.)

154.45

30229

Muscle, excision of (extensive) (Anaes.) (Assist.)

281.45

30232

Muscle, ruptured, repair of (limited), not associated with external wound (Anaes.)

230.60

30235

Muscle, ruptured, repair of (extensive), not associated with external wound (Anaes.) (Assist.)

304.95

30238

Fascia, deep, repair of, for herniated muscle (Anaes.)

154.45

30241

Bone tumour, innocent, excision of, other than a service to which another item in this Group applies (Anaes.) (Assist.)

367.50

30244

Styloid process of temporal bone, removal of (H) (Anaes.) (Assist.)

367.50

30246

Parotid duct, repair of, using microsurgical techniques (H) (Anaes.) (Assist.)

711.35

30247

Parotid gland, total extirpation of (H) (Anaes.) (Assist.)

762.45

30250

Parotid gland, total extirpation of with preservation of facial nerve (H) (Anaes.) (Assist.)

1,290.15

30251

Recurrent parotid tumour, excision of, with preservation of facial nerve (Anaes.) (Assist.)

1,981.80

30253

Parotid gland, superficial lobectomy of, with exposure of facial nerve (H) (Anaes.) (Assist.)

860.10

30255

Submandibular ducts, relocation of, for surgical control of drooling (H) (Anaes.) (Assist.)

1,145.35

30256

Submandibular gland, extirpation of (H) (Anaes.) (Assist.)

459.35

30259

Sublingual gland, extirpation of (Anaes.)

204.75

30262

Salivary gland, dilatation or diathermy of duct (Anaes.)

60.65

30266

Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, one or more such procedures (Anaes.)

154.45

30269

Salivary gland, repair of cutaneous fistula of (Anaes.)

154.45

30272

Tongue, partial excision of (Anaes.) (Assist.)

304.95

30275

Radical excision of intraoral tumour involving resection of mandible and lymph nodes of neck (commandotype operation) (H) (Anaes.) (Assist.)

1,817.80

30278

Tongue tie, repair of, other than a service to which another item in this Group applies (Anaes.)

47.95

30281

Tongue tie, mandibular frenulum or maxillary frenulum, repair of, in a person aged 2 years and over, under general anaesthesia (Anaes.)

123.20

30283

Ranula or mucous cyst of mouth, removal of (Anaes.)

211.10

30286

Branchial cyst, removal of, on a person 10 years of age or over (Anaes.) (Assist.)

410.25

30287

Branchial cyst, removal of, on a person under 10 years of age (Anaes.) (Assist.)

533.40

30289

Branchial fistula, removal of, on a person 10 years of age or over (H) (Anaes.) (Assist.)

517.95

30293

Cervical oesophagostomy, or closure of cervical oesophagostomy with or without plastic repair (Anaes.) (Assist.)

459.35

30294

Cervical oesophagectomy with tracheostomy and oesophagostomy, with or without plastic reconstruction, or laryngopharyngectomy with tracheostomy and plastic reconstruction (H) (Anaes.) (Assist.)

1,817.80

30296

Thyroidectomy, total (H) (Anaes.) (Assist.)

1,055.70

30297

Thyroidectomy following previous thyroid surgery (H) (Anaes.) (Assist.)

1,055.70

30299

Sentinel lymph node biopsy, or biopsies, for breast cancer:

(a) involving dissection in a level one axilla; and

(b) using preoperative lymphoscintigraphy and lymphotropic dye injection;

other than a service to which item 30300, 30302 or 30303 applies (H) (Anaes.) (Assist.)

657.35

30300

Sentinel lymph node biopsy, or biopsies, for breast cancer:

(a) involving dissection in a level 2 or 3 axilla; and

(b) using preoperative lymphoscintigraphy and lymphotropic dye injection;

other than a service to which item 30299, 30302 or 30303 applies (H) (Anaes.) (Assist.)

788.80

30302

Sentinel lymph node biopsy, or biopsies, for breast cancer:

(a) involving dissection in a level one axilla; and

(b) using lymphotropic dye injection;

other than a service to which item 30299, 30300 or 30303 applies (H) (Anaes.) (Assist.)

525.85

30303

Sentinel lymph node biopsy, or biopsies, for breast cancer:

(a) involving dissection in a level 2 or 3 axilla; and

(b) using lymphotropic dye injection;

other than a service to which item 30299, 30300 or 30302 applies (H) (Anaes.) (Assist.)

630.95

30306

Total hemithyroidectomy (H) (Anaes.) (Assist.)

823.60

30310

Partial or subtotal thyroidectomy (H) (Anaes.) (Assist.)

823.60

30314

Thyroglossal cyst or fistula or both, radical removal of, including thyroglossal duct and portion of hyoid bone, on a person 10 years of age or over (H) (Anaes.) (Assist.)

471.65

30315

Minimally invasive parathyroidectomy. Removal of one or more parathyroid adenomas through a small cervical incision for an image localised adenoma, including thymectomy

Applicable only once per occasion on which the service is provided

Not applicable to a service performed in association with a service to which item 30317, 30318 or 30320 applies

(H) (Anaes.) (Assist.)

1,175.50

30317

Redo parathyroidectomy. Cervical reexploration for persistent or recurrent hyperparathyroidism, including thymectomy and cervical exploration of the mediastinum

Applicable only once per occasion on which the service is provided

Not applicable to a service performed in association with a service to which item 30315, 30318 or 30320 applies

(H) (Anaes.) (Assist.)

1,407.55

30318

Open parathyroidectomy, exploration and removal of one or more adenomas or hyperplastic glands via a cervical incision including thymectomy and cervical exploration of the mediastinum (when performed)

Applicable only once per occasion on which the service is provided

Not applicable to a service performed in association with a service to which item 30315, 30317 or 30320 applies

(H) (Anaes.) (Assist.)

1,175.50

30320

Removal of a mediastinal parathyroid adenoma via sternotomy or mediastinal thorascopic approach

Applicable only once per occasion on which the service is provided

Not applicable to a service performed in association with a service to which item 30315, 30317 or 30318 applies

(H) (Anaes.) (Assist.)

1,407.55

30323

Excision of phaeochromocytoma or extraadrenal paraganglioma via endoscopic or open approach (H) (Anaes.) (Assist.)

1,407.55

30324

Excision of an adrenocortical tumour or hyperplasia via endoscopic or open approach (H) (Anaes.) (Assist.)

1,407.55

30326

Thyroglossal cyst or fistula or both, radical removal of, including thyroglossal duct and portion of hyoid bone, on a person under 10 years of age (H) (Anaes.) (Assist.)

613.15

30329

Lymph nodes of groin, limited excision of (Anaes.)

254.65

30330

Lymph nodes of groin, radical excision of (H) (Anaes.) (Assist.)

741.20

30332

Lymph nodes of axilla, limited excision of (sampling) (H) (Anaes.) (Assist.)

357.60

30335

Lymph nodes of axilla, complete excision of, to level I (H) (Anaes.) (Assist.)

893.90

30336

Lymph nodes of axilla, complete excision of, to level II or III (H) (Anaes.) (Assist.)

1,072.75

30373

Laparotomy (exploratory), including associated biopsies, if no other intraabdominal procedure is performed (H) (Anaes.) (Assist.)

498.35

30375

Caecostomy, enterostomy, colostomy, enterotomy, colotomy, cholecystostomy, gastrostomy, gastrotomy, reduction of intussusception, removal of Meckel’s diverticulum, suture of perforated peptic ulcer, simple repair of ruptured viscus, reduction of volvulus, pyloroplasty or drainage of pancreas, on a person 10 years of age or over (H) (Anaes.) (Assist.)

537.55

30376

Laparotomy involving division of peritoneal adhesions (if no other intraabdominal procedure is performed), on a person 10 years of age or over (H) (Anaes.) (Assist.)

537.55

30378

Laparotomy involving division of adhesions in association with another intraabdominal procedure if the time taken to divide the adhesions is between 45 minutes and 2 hours, on a person 10 years of age or over (H) (Anaes.) (Assist.)

540.10

30379

Laparotomy with division of extensive adhesions (lasting more than 2 hours) with or without insertion of long intestinal tube (H) (Anaes.) (Assist.)

957.15

30382

Enterocutaneous fistula, radical repair of, involving extensive dissection and resection of bowel (H) (Anaes.) (Assist.)

1,347.70

30384

Laparotomy for grading of lymphoma, including splenectomy, liver biopsies, lymph node biopsies and oophoropexy (H) (Anaes.) (Assist.)

1,133.75

30385

Laparotomy for control of postoperative haemorrhage, if no other procedure is performed (H) (Anaes.) (Assist.)

580.90

30387

Laparotomy involving operation on abdominal viscera (including pelvic viscera), other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

654.85

30388

Laparotomy for trauma involving 3 or more organs (H) (Anaes.) (Assist.)

1,647.45

30390

Laparoscopy, diagnostic, on a person 10 years of age or over, other than a service associated with another laparoscopic procedure (H) (Anaes.)

226.80

30391

Laparoscopy, with biopsy (H) (Anaes.) (Assist.)

293.25

30392

Radical or debulking operation for advanced intraabdominal malignancy, with or without omentectomy, as an independent procedure (H) (Anaes.) (Assist.)

695.60

30393

Laparoscopic division of adhesions in association with another intraabdominal procedure if the time taken to divide the adhesions exceeds 45 minutes (H) (Anaes.) (Assist.)

540.10

30394

Laparotomy for drainage of subphrenic abscess, pelvic abscess, appendiceal abscess, ruptured appendix or for peritonitis from any cause, with or without appendicectomy (H) (Anaes.) (Assist.)

508.25

30396

Laparotomy for gross intra peritoneal sepsis requiring debridement of fibrin, with or without removal of foreign material or enteric contents, with lavage of the entire peritoneal cavity via a major abdominal incision with or without closure of abdomen and with or without mesh or zipper insertion (H) (Anaes.) (Assist.)

1,048.30

30397

Laparostomy, via wound previously made and left open or closed with zipper, involving change of dressings or packs, and with or without drainage of loculated collections (H) (Anaes.)

239.60

30399

Laparostomy, final closure of wound made at previous operation, after removal of dressings or packs and removal of mesh or zipper if previously inserted (H) (Anaes.) (Assist.)

329.55

30400

Laparotomy with insertion of portacath for administration of cytotoxic therapy including placement of reservoir (H) (Anaes.) (Assist.)

652.25

30402

Retroperitoneal abscess, drainage of, not involving laparotomy (H) (Anaes.) (Assist.)

479.15

30403

Ventral, incisional, or recurrent hernia or burst abdomen, repair of, with or without mesh (H) (Anaes.) (Assist.)

537.55

30405

Ventral or incisional hernia (other than recurrent inguinal or femoral hernia), repair of, requiring muscle transposition, mesh hernioplasty or resection of strangulated bowel (H) (Anaes.) (Assist.)

943.55

30406

Paracentesis abdominis (Anaes.)

53.85

30408

Peritoneo venous shunt, insertion of (H) (Anaes.) (Assist.)

404.35

30409

Liver biopsy, percutaneous (Anaes.)

179.90

30411

Liver biopsy by wedge excision when performed in association with another intraabdominal procedure (H) (Anaes.)

91.55

30412

Liver biopsy by core needle, when performed in conjunction with another intraabdominal procedure (Anaes.)

54.00

30414

Liver, subsegmental resection of, (local excision), other than for trauma (H) (Anaes.) (Assist.)

711.35

30415

Liver, segmental resection of, other than for trauma (H) (Anaes.) (Assist.)

1,422.55

30416

Liver cyst, laparoscopic marsupialisation of, if the size of the cyst is greater than 5 cm in diameter (H) (Anaes.) (Assist.)

772.35

30417

Liver cysts, laparoscopic marsupialisation of 5 or more, including any cyst greater than 5 cm in diameter (H) (Anaes.) (Assist.)

1,158.45

30418

Liver, lobectomy of, other than for trauma (H) (Anaes.) (Assist.)

1,647.45

30419

Liver tumours, destruction of, by hepatic cryotherapy, other than a service associated with a service to which item 50950 or 50952 applies (Anaes.) (Assist.)

842.60

30421

Liver, trisegmental resection (extended lobectomy) of, other than for trauma (H) (Anaes.) (Assist.)

2,058.95

30422

Liver, repair of superficial laceration of, for trauma (H) (Anaes.) (Assist.)

696.45

30425

Liver, repair of deep multiple lacerations of, or debridement of, for trauma (H) (Anaes.) (Assist.)

1,347.70

30427

Liver, segmental resection of, for trauma (H) (Anaes.) (Assist.)

1,609.75

30428

Liver, lobectomy of, for trauma (Anaes.) (Assist.)

1,722.15

30430

Liver, extended lobectomy (trisegmental resection) of, for trauma (Anaes.) (Assist.)

2,395.85

30431

Liver abscess, open abdominal drainage of (Anaes.) (Assist.)

537.55

30433

Liver abscess (multiple), open abdominal drainage of (H) (Anaes.) (Assist.)

748.70

30434

Hydatid cyst of liver, peritoneum or viscus, complete removal of contents of, with or without suture of biliary radicles (H) (Anaes.) (Assist.)

606.50

30436

Hydatid cyst of liver, peritoneum or viscus, complete removal of contents of, with or without suture of biliary radicles, with omentoplasty or myeloplasty (H) (Anaes.) (Assist.)

673.85

30437

Hydatid cyst of liver, total excision of, by cystopericystectomy (membrane plus fibrous wall) (H) (Anaes.) (Assist.)

838.70

30438

Hydatid cyst of liver, excision of, with drainage and excision of liver tissue (Anaes.) (Assist.)

1,186.80

30439

Operative cholangiography or operative pancreatography or intra operative ultrasound of the biliary tract (including one or more examinations performed during the one operation) (H) (Anaes.) (Assist.)

191.40

30440

Cholangiogram, percutaneous transhepatic, and insertion of biliary drainage tube, using interventional imaging techniques, other than a service associated with a service to which item 30451 applies (Anaes.) (Assist.)

542.80

30441

Intra operative ultrasound for staging of intra abdominal tumours (H) (Anaes.)

140.55

30442

Choledochoscopy in conjunction with another procedure (H) (Anaes.)

191.40

30443

Cholecystectomy (H) (Anaes.) (Assist.)

762.45

30445

Laparoscopic cholecystectomy (H) (Anaes.) (Assist.)

762.45

30446

Laparoscopic cholecystectomy when procedure is completed by laparotomy (H) (Anaes.) (Assist.)

762.45

30448

Laparoscopic cholecystectomy, involving removal of common duct calculi via the cystic duct (H) (Anaes.) (Assist.)

1,003.30

30449

Laparoscopic cholecystectomy with removal of common duct calculi via laparoscopic choledochotomy (H) (Anaes.) (Assist.)

1,115.65

30450

Calculus of biliary or renal tract, extraction of, using interventional imaging techniques—other than a service associated with a service to which item 36627, 36630, 36645 or 36648 applies (Anaes.) (Assist.)

540.80

30451

Biliary drainage tube, exchange of, using interventional imaging techniques, other than a service associated with a service to which item 30440 applies (Anaes.) (Assist.)

276.05

30452

Choledochoscopy with balloon dilatation of a stricture or passage of stent or extraction of calculi (H) (Anaes.) (Assist.)

389.30

30454

Choledochotomy (with or without cholecystectomy), with or without removal of calculi (H) (Anaes.) (Assist.)

889.45

30455

Choledochotomy (with or without cholecystectomy), with removal of calculi including biliary intestinal anastomosis (H) (Anaes.) (Assist.)

1,045.70

30457

Choledochotomy, intrahepatic, involving removal of intrahepatic bile duct calculi (Anaes.) (Assist.)

1,422.55

30458

Transduodenal operation on sphincter of Oddi, involving one or more of, removal of calculi, sphincterotomy, sphincteroplasty, biopsy, local excision of periampullary or duodenal tumour, sphincteroplasty of the pancreatic duct, pancreatic duct septoplasty, with or without choledochotomy (H) (Anaes.) (Assist.)

1,045.70

30460

Cholecystoduodenostomy, cholecystoenterostomy, choledochojejunostomy or RouxenY as a bypass procedure when no prior biliary surgery performed (H) (Anaes.) (Assist.)

889.45

30461

Radical resection of porta hepatis with biliaryenteric anastomoses, other than a service associated with a service to which item 30443, 30454, 30455, 30458 or 30460 applies (H) (Anaes.) (Assist.)

1,524.60

30463

Radical resection of common hepatic duct and right and left hepatic ducts, with 2 duct anastomoses (H) (Anaes.) (Assist.)

1,871.90

30464

Radical resection of common hepatic duct and right and left hepatic ducts involving more than 2 anastomoses or resection of segment or major portion of segment of liver (H) (Anaes.) (Assist.)

2,246.30

30466

Intrahepatic biliary bypass of left hepatic ductal system by RouxenY loop to peripheral ductal system (H) (Anaes.) (Assist.)

1,295.30

30467

Intrahepatic bypass of right hepatic ductal system by RouxenY loop to peripheral ductal system (H) (Anaes.) (Assist.)

1,602.25

30469

Biliary stricture, repair of, after one or more operations on the biliary tree (Anaes.) (Assist.)

1,774.70

30472

Hepatic or common bile duct, repair of, as the primary procedure after partial or total transection of bile duct or ducts (Anaes.) (Assist.)

958.35

30473

Oesophagoscopy (other than a service to which item 41816 or 41822 applies), gastroscopy, duodenoscopy or panendoscopy (one or more such procedures), with or without biopsy, other than a service associated with a service to which item 30478 or 30479 applies (Anaes.)

182.65

30475

Endoscopic dilatation of stricture of upper gastrointestinal tract (including the use of imaging intensification if clinically indicated) (Anaes.)

359.85

30478

Oesophagoscopy (other than a service to which item 41816, 41822 or 41825 applies), gastroscopy, duodenoscopy, panendoscopy or push enteroscopy, one or more such procedures, if:

(a) the procedures are performed using one or more of the following endoscopic procedures:

(i) polypectomy;

(ii) sclerosing or adrenalin injections;

(iii) banding;

(iv) endoscopic clips;

(v) haemostatic powders;

(vi) diathermy;

(vii) argon plasma coagulation; and

(b) the procedures are for the treatment of one or more of the following:

(i) upper gastrointestinal tract bleeding;

(ii) polyps;

(iii) removal of foreign body;

(iv) oesophageal or gastric varices;

(v) peptic ulcers;

(vi) neoplasia;

(vii) benign vascular lesions;

(viii) strictures of the gastrointestinal tract;

(ix) tumorous overgrowth through or over oesophageal stents;

other than a service associated with a service to which item 30473 or 30479 applies (Anaes.)

253.25

30479

Endoscopy with laser therapy, for the treatment of one or more of the following:

(a) neoplasia;

(b) benign vascular lesions;

(c) strictures of the gastrointestinal tract;

(d) tumorous overgrowth through or over oesophageal stents;

(e) peptic ulcers;

(f) angiodysplasia;

(g) gastric antral vascular ectasia;

(h) postpolypectomy bleeding;

other than a service associated with a service to which item 30473 or 30478 applies (Anaes.)

490.95

30481

Percutaneous gastrostomy (initial procedure):

(a) including any associated imaging services; and

(b) excluding the insertion of a device for the purpose of facilitating weight loss

(Anaes.)

368.15

30482

Percutaneous gastrostomy (repeat procedure):

(a) including any associated imaging services; and

(b) excluding the insertion of a device for the purpose of facilitating weight loss

(Anaes.)

261.75

30483

Gastrostomy button, caecostomy antegrade enema device (chait etc.) or stomal indwelling device:

(a) nonendoscopic insertion of; or

(b) nonendoscopic replacement of;

on a person 10 years of age or over, excluding the insertion of a device for the purpose of facilitating weight loss (Anaes.)

182.60

30484

Endoscopic retrograde cholangiopancreatography (Anaes.)

376.30

30485

Endoscopic sphincterotomy with or without extraction of stones from common bile duct (Anaes.)

580.90

30488

Small bowel intubation—as an independent procedure (Anaes.)

92.80

30490

Oesophageal prosthesis, insertion of, including endoscopy and dilatation (Anaes.)

542.80

30491

Bile duct, endoscopic stenting of (including endoscopy and dilatation) (Anaes.)

572.70

30492

Bile duct, percutaneous stenting of (including dilatation when performed), using interventional imaging techniques (H) (Anaes.)

811.90

30494

Endoscopic biliary dilatation (H) (Anaes.)

433.65

30495

Percutaneous biliary dilatation for biliary stricture using interventional imaging techniques (H) (Anaes.)

811.90

30496

Vagotomy, truncal or selective, with or without pyloroplasty or gastroenterostomy (Anaes.) (Assist.)

606.50

30497

Vagotomy and antrectomy (H) (Anaes.) (Assist.)

723.20

30499

Vagotomy, highly selective (H) (Anaes.) (Assist.)

860.10

30500

Vagotomy, highly selective with duodenoplasty for peptic stricture (Anaes.) (Assist.)

921.00

30502

Vagotomy, highly selective, with dilatation of pylorus (H) (Anaes.) (Assist.)

1,016.45

30503

Vagotomy or antrectomy, or both, for peptic ulcer following previous operation for peptic ulcer (Anaes.) (Assist.)

1,138.25

30505

Bleeding peptic ulcer, control of, involving suture of bleeding point or wedge excision (H) (Anaes.) (Assist.)

569.10

30506

Bleeding peptic ulcer, control of, involving suture of bleeding point or wedge excision, and vagotomy and pyloroplasty or gastroenterostomy (H) (Anaes.) (Assist.)

995.90

30508

Bleeding peptic ulcer, control of, involving suture of bleeding point or wedge excision, and highly selective vagotomy (H) (Anaes.) (Assist.)

1,048.30

30509

Bleeding peptic ulcer, control of, involving gastric resection (other than wedge resection) (Anaes.) (Assist.)

1,048.30

30515

Gastroenterostomy (including gastroduodenostomy) or enterocolostomy or enteroenterostomy, not being a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)

726.35

30517

Gastroenterostomy, pyloroplasty or gastroduodenostomy, reconstruction of (H) (Anaes.) (Assist.)

951.00

30518

Partial gastrectomy, not being a service associated with a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)

1,018.35

30520

Gastric tumour, removal of, by local excision, other than a service to which item 30518 applies (H) (Anaes.) (Assist.)

696.45

30521

Gastrectomy, total, for benign disease (H) (Anaes.) (Assist.)

1,490.00

30523

Gastrectomy, subtotal radical, for carcinoma (including splenectomy when performed) (H) (Anaes.) (Assist.)

1,557.25

30524

Gastrectomy, total radical, for carcinoma (including extended node dissection and distal pancreatectomy and splenectomy when performed) (H) (Anaes.) (Assist.)

1,714.60

30526

Gastrectomy, total, and including lower oesophagus, performed by left thoracoabdominal incision or opening of diaphragmatic hiatus (including splenectomy when performed) (H) (Anaes.) (Assist.)

2,223.70

30527

Antireflux operation by fundoplasty, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus—other than a service to which item 30601 applies (H) (Anaes.) (Assist.)

898.55

30529

Antireflux operation by fundoplasty, with oesophagoplasty for stricture or short oesophagus (H) (Anaes.) (Assist.)

1,347.70

30530

Antireflux operation by cardiopexy, with or without fundoplasty (H) (Anaes.) (Assist.)

808.70

30532

Oesophagogastric myotomy (Heller’s operation) via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, by laparoscopy or open operation (H) (Anaes.) (Assist.)

928.55

30533

Oesophagogastric myotomy (Heller’s operation) via abdominal or thoracic approach, with fundoplasty, with or without closure of the diaphragmatic hiatus, by laparoscopy or open operation (H) (Anaes.) (Assist.)

1,104.45

30535

Oesophagectomy with gastric reconstruction by abdominal mobilisation and thoracotomy (H) (Anaes.) (Assist.)

1,749.65

30536

Oesophagectomy involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest—one surgeon (H) (Anaes.) (Assist.)

1,774.70

30538

Oesophagectomy involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest—conjoint surgery, principal surgeon (including aftercare) (H) (Anaes.) (Assist.)

1,228.00

30539

Oesophagectomy involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest—conjoint surgery, cosurgeon (H) (Assist.)

898.55

30541

Oesophagectomy, by transhiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement—one surgeon (H) (Anaes.) (Assist.)

1,564.95

30542

Oesophagectomy, by transhiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement—conjoint surgery, principal surgeon (including aftercare) (H) (Anaes.) (Assist.)

1,063.30

30544

Oesophagectomy, by transhiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement—conjoint surgery, cosurgeon (H) (Assist.)

778.80

30545

Oesophagectomy with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis)—one surgeon (H) (Anaes.) (Assist.)

1,894.50

30547

Oesophagectomy with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis)—conjoint surgery, principal surgeon (including aftercare) (Anaes.) (Assist.)

1,302.80

30548

Oesophagectomy with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis)—conjoint surgery, cosurgeon (Assist.)

973.30

30550

Oesophagectomy with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck)—one surgeon (H) (Anaes.) (Assist.)

2,126.65

30551

Oesophagectomy with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck)—conjoint surgery, principal surgeon (including aftercare) (H) (Anaes.) (Assist.)

1,467.60

30553

Oesophagectomy with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck)—conjoint surgery, cosurgeon (Assist.)

1,085.55

30554

Oesophagectomy with reconstruction by free jejunal graft—one surgeon (H) (Anaes.) (Assist.)

2,366.10

30556

Oesophagectomy with reconstruction by free jejunal graft—conjoint surgery, principal surgeon (including aftercare) (H) (Anaes.) (Assist.)

1,632.20

30557

Oesophagectomy with reconstruction by free jejunal graft—conjoint surgery, cosurgeon (H) (Assist.)

1,205.50

30559

Oesophagus, local excision for tumour of (Anaes.) (Assist.)

876.10

30560

Oesophageal perforation, repair of, by thoracotomy (H) (Anaes.) (Assist.)

973.30

30562

Enterostomy or colostomy, closure of (not involving resection of bowel), on a person 10 years of age or over (H) (Anaes.) (Assist.)

613.55

30563

Colostomy or ileostomy, refashioning of, on a person 10 years of age or over (Anaes.) (Assist.)

613.55

30564

Small bowel strictureplasty for chronic inflammatory bowel disease (H) (Anaes.) (Assist.)

796.40

30565

Small intestine, resection of, without anastomosis (including formation of stoma) (H) (Anaes.) (Assist.)

898.55

30566

Small intestine, resection of, with anastomosis, on a person 10 years of age or over (H) (Anaes.) (Assist.)

998.10

30568

Intraoperative enterotomy for visualisation of the small intestine by endoscopy (H) (Anaes.) (Assist.)

748.70

30569

Endoscopic examination of small bowel with flexible endoscope passed at laparotomy, with or without biopsies (H) (Anaes.) (Assist.)

381.75

30571

Appendicectomy, on a person 10 years of age or over, other than a service to which item 30574 applies (H) (Anaes.) (Assist.)

459.35

30572

Laparoscopic appendicectomy, on a person 10 years of age or over (H) (Anaes.) (Assist.)

459.35

30574

Appendicectomy, when performed in conjunction with another intraabdominal procedure through the same incision (H) (Anaes.)

127.10

30575

Pancreatic abscess, laparotomy and external drainage of, not requiring retropancreatic dissection (H) (Anaes.) (Assist.)

528.70

30577

Pancreatic necrosectomy for pancreatic necrosis or abscess formation requiring major pancreatic or retropancreatic dissection, excluding aftercare (H) (Anaes.) (Assist.)

1,123.20

30578

Endocrine tumour, exploration of pancreas or duodenum, followed by local excision of pancreatic tumour (H) (Anaes.) (Assist.)

1,183.05

30580

Endocrine tumour, exploration of pancreas or duodenum, followed by local excision of duodenal tumour (H) (Anaes.) (Assist.)

1,078.10

30581

Endocrine tumour, exploration of pancreas or duodenum for, but no tumour found (H) (Anaes.) (Assist.)

786.15

30583

Distal pancreatectomy (H) (Anaes.) (Assist.)

1,231.55

30584

Pancreaticoduodenectomy, Whipple’s operation, with or without preservation of pylorus (H) (Anaes.) (Assist.)

1,817.80

30586

Pancreatic cystanastomosis to stomach or duodenum—by open or endoscopic means (H) (Anaes.) (Assist.)

723.20

30587

Pancreatic cyst, anastomosis to Roux loop of jejunum (H) (Anaes.) (Assist.)

748.70

30589

Pancreaticojejunostomy for pancreatitis or trauma (H) (Anaes.) (Assist.)

1,290.15

30590

Pancreaticojejunostomy following previous pancreatic surgery (H) (Anaes.) (Assist.)

1,422.55

30593

Pancreatectomy, near total or total (including duodenum), with or without splenectomy (Anaes.) (Assist.)

1,946.70

30594

Pancreatectomy for pancreatitis following previously attempted drainage procedure or partial resection (H) (Anaes.) (Assist.)

2,246.30

30596

Splenorrhaphy or partial splenectomy (H) (Anaes.) (Assist.)

925.30

30597

Splenectomy (H) (Anaes.) (Assist.)

742.70

30599

Splenectomy, for massive spleen (weighing more than 1,500 g) or involving thoracoabdominal incision (H) (Anaes.) (Assist.)

1,347.70

30600

Diaphragmatic hernia, traumatic, repair of (H) (Anaes.) (Assist.)

801.40

30601

Diaphragmatic hernia, congenital, repair of, by thoracic or abdominal approach, on a person 10 years of age or over, not being a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)

987.20

30602

Portal hypertension, portocaval shunt for (H) (Anaes.) (Assist.)

1,602.25

30603

Portal hypertension, mesocaval shunt for (Anaes.) (Assist.)

1,692.15

30605

Portal hypertension, selective splenorenal shunt for (H) (Anaes.) (Assist.)

1,924.25

30606

Portal hypertension, oesophageal transection via stapler or oversew of gastric varices with or without devascularisation (H) (Anaes.) (Assist.)

1,145.50

30608

Small intestine, resection of, with anastomosis, on a person under 10 years of age (H) (Anaes.) (Assist.)

1,297.55

30609

Femoral or inguinal hernia, laparoscopic repair of, other than a service associated with a service to which item 30614 applies (H) (Anaes.) (Assist.)

479.05

30611

Benign tumour of soft tissue (other than tumours of skin, cartilage and bone, simple lipomas covered by item 31345 and lipomata), removal of, by surgical excision, on a person under 10 years of age, if the specimen excised is sent for histological confirmation of diagnosis, other than a service to which another item in this Group applies (Anaes.) (Assist.)

580.95

30614

Femoral or inguinal hernia or infantile hydrocele, repair of, on a person 10 years of age or over, other than a service to which item 30403 or 30615 applies (H) (Anaes.) (Assist.)

479.05

30615

Strangulated, incarcerated or obstructed hernia, repair of, without bowel resection, on a person 10 years of age or over (H) (Anaes.) (Assist.)

537.55

30618

Lymph nodes of neck, selective dissection of one or 2 lymph node levels involving removal of soft tissue and lymph nodes from one side of the neck, on a person under 10 years of age (Anaes.) (Assist.)

538.55

30619

Laparoscopic splenectomy, on a person under 10 years of age (H) (Anaes.) (Assist.)

965.50

30621

Repair of symptomatic umbilical, epigastric or linea alba hernia requiring mesh or other formal repair of, in a person 10 years of age or over, other than a service to which item 30403 or 30405 applies (H) (Anaes.) (Assist.)

420.20

30622

Caecostomy, enterostomy, colostomy, enterotomy, colotomy, cholecystostomy, gastrostomy, gastrotomy, reduction of intussusception, removal of Meckel’s diverticulum, suture of perforated peptic ulcer, simple repair of ruptured viscus, reduction of volvulus, pyloroplasty or drainage of pancreas, on a person under 10 years of age (H) (Anaes.) (Assist.)

698.85

30623

Laparotomy involving division of peritoneal adhesions (if no other intraabdominal procedure is performed), on a person under 10 years of age (H) (Anaes.) (Assist.)

698.85

30626

Laparotomy involving division of adhesions in association with another intraabdominal procedure if the time taken to divide the adhesions is between 45 minutes and 2 hours, on a person under 10 years of age (H) (Anaes.) (Assist.)

702.10

30627

Laparoscopy, diagnostic, other than a service associated with another laparoscopic procedure, on a person under 10 years of age (H) (Anaes.)

294.90

30628

Hydrocele, tapping of

36.70

30631

Hydrocele, removal of, other than a service associated with a service to which item 30641, 30642 or 30644 applies (Anaes.)

244.05

30635

Varicocele, surgical correction of, other than a service associated with a service to which item 30641, 30642 or 30644 applies—one procedure (H) (Anaes.) (Assist.)

300.90

30636

Gastrostomy button, caecostomy antegrade enema device (chait etc.) or stomal indwelling device, nonendoscopic insertion of, or nonendoscopic replacement of, on a person under 10 years of age (Anaes.)

240.45

30637

Enterostomy or colostomy, closure of (not involving resection of bowel), on a person under 10 years of age (H) (Anaes.) (Assist.)

797.70

30639

Colostomy or ileostomy, refashioning of, on a person under 10 years of age (Anaes.) (Assist.)

797.70

30640

Repair of large and irreducible scrotal hernia, if surgery exceeds 2 hours, in a person 10 years of age or over, other than a service to which item 30403, 30405, 30614, 30615 or 30621 applies (H) (Anaes.) (Assist.)

943.55

30641

Orchidectomy, simple or subcapsular, unilateral with or without insertion of testicular prosthesis (H) (Anaes.) (Assist.)

420.20

30642

Orchidectomy, radical, unilateral, with or without insertion of testicular prosthesis, other than a service associated with a service to which item 30631, 30635, 30641, 30643 or 30644 applies (H) (Anaes.) (Assist.)

537.55

30643

Exploration of spermatic cord, inguinal approach, with or without testicular biopsy and with or without excision of spermatic cord and testis, on a person under 10 years of age (H) (Anaes.) (Assist.)

698.85

30644

Exploration of spermatic cord, inguinal approach, with or without testicular biopsy and with or without excision of spermatic cord and testis, on a person 10 years of age or over (H) (Anaes.) (Assist.)

537.55

30645

Appendicectomy, on a person under 10 years of age, other than a service to which item 30574 applies (H) (Anaes.) (Assist.)

597.05

30646

Laparoscopic appendicectomy, on a person under 10 years of age (H) (Anaes.) (Assist.)

597.05

30649

Haemorrhage, arrest of, following circumcision requiring general anaesthesia, on a person under 10 years of age (Anaes.)

193.50

30654

Circumcision of the penis (other than a service to which item 30658 applies)

47.95

30658

Circumcision of the penis, when performed in conjunction with a service to which an item in Group T7 or Group T10 applies (Anaes.)

146.40

30663

Haemorrhage, arrest of, following circumcision requiring general anaesthesia, on a person 10 years of age or over (Anaes.)

148.85

30666

Paraphimosis or phimosis, reduction of, under general anaesthesia, with or without dorsal incision, other than a service associated with a service to which another item in this Group applies (Anaes.)

48.90

30672

Coccyx, excision of (H) (Anaes.) (Assist.)

459.35

30676

Pilonidal sinus or cyst, or sacral sinus or cyst, excision of (Anaes.)

390.90

30679

Pilonidal sinus, injection of sclerosant fluid under anaesthesia (Anaes.)

99.30

30680

Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, without intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding if the patient:

(a) has recurrent or persistent bleeding; and

(b) is anaemic or has active bleeding; and

(c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this Subgroup (other than item 30682 or 30686) (Anaes.)

1,206.55

30682

Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, without intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding if the patient:

(a) has recurrent or persistent bleeding; and

(b) is anaemic or has active bleeding; and

(c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this Subgroup (other than item 30680 or 30684) (Anaes.)

1,206.55

30684

Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, with one or more of the following procedures—snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation, for diagnosis and management of patients with obscure gastrointestinal bleeding if the patient:

(a) has recurrent or persistent bleeding; and

(b) is anaemic or has active bleeding; and

(c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this Subgroup (other than item 30682 or 30686) (Anaes.)

1,484.85

30686

Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, with one or more of the following procedures—snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation, for diagnosis and management of patients with obscure gastrointestinal bleeding if the patient:

(a) has recurrent or persistent bleeding; and

(b) is anaemic or has active bleeding; and

(c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this Subgroup (other than item 30680 or 30684) (Anaes.)

1,484.85

30687

Endoscopy with radiofrequency ablation of mucosal metaplasia for the treatment of Barrett’s Oesophagus in a single course of treatment, following diagnosis of high grade dysplasia confirmed by histological examination (Anaes.)

490.95

30688

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the staging of one or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

376.30

30690

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, with fine needle aspiration (including aspiration of the locoregional lymph nodes if performed, for the staging of one or more of oesophageal, gastric or pancreatic cancer), not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

580.90

30692

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of one or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

376.30

30694

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, with fine needle aspiration for the diagnosis of one or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

580.90

30696

Endoscopic ultrasound guided fine needle aspiration biopsy or biopsies (endoscopy with ultrasound imaging) to obtain one or more specimens from either:

(a) mediastinal masses; or

(b) locoregional nodes to stage nonsmall cell lung carcinoma;

other than a service associated with another item in this Subgroup or to which items 30710, 55054 apply (Anaes.)

580.90

30710

Endobronchial ultrasound guided biopsy or biopsies (bronchoscopy with ultrasound imaging, with or without associated fluoroscopic imaging) to obtain one or more specimens by:

(a) transbronchial biopsy or biopsies of peripheral lung lesions; or

(b) fine needle aspirations of one or more mediastinal masses; or

(c) fine needle aspirations of locoregional nodes to stage nonsmall cell lung carcinoma;

other than a service associated with another item in this Subgroup or to which items 30696, 41892, 41898, or 60500 to 60509 applies (Anaes.)

580.90

31000

Mohs surgery of skin tumour located on the head, neck, genitalia, hand, digits, leg (below knee) or foot, utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure, if the specialist is recognised by the Australasian College of Dermatologists as an approved Mohs surgeon—6 or fewer sections (Anaes.)

599.05

31001

Mohs surgery of skin tumour located on the head, neck, genitalia, hand, digits, leg (below knee) or foot, utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure, if the specialist is recognised by the Australasian College of Dermatologists as an approved Mohs surgeon—7 to 12 sections (inclusive) (Anaes.)

748.70

31002

Mohs surgery of skin tumour located on the head, neck, genitalia, hand, digits, leg (below knee) or foot, utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure, if the specialist is recognised by the Australasian College of Dermatologists as an approved Mohs surgeon—13 or more sections (Anaes.)

898.55

31003

Mohs surgery of skin tumour utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure, if the specialist is recognised by the Australasian College of Dermatologists as an approved Mohs surgeon—6 or fewer sections

Not applicable to a service performed in association with a service to which item 31000 applies (Anaes.)

599.05

31004

Mohs surgery of skin tumour utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure, if the specialist is recognised by the Australasian College of Dermatologists as an approved Mohs surgeon—7 to 12 sections (inclusive)

Not applicable to a service performed in association with a service to which item 31001 applies (Anaes.)

748.70

31005

Mohs surgery of skin tumour utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure, if the specialist is recognised by the Australasian College of Dermatologists as an approved Mohs surgeon—13 or more sections

Not applicable to a service performed in association with a service to which item 31002 applies (Anaes.)

898.55

31206

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), removal of and suture, if:

(a) the lesion size is not more than 10 mm in diameter; and

(b) the removal is from a mucous membrane by surgical excision (other than by shave excision); and

(c) the specimen excised is sent for histological examination (Anaes.)

98.45

31211

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), removal of and suture, if:

(a) the lesion size is more than 10 mm, but not more than 20 mm, in diameter; and

(b) the removal is from a mucous membrane by surgical excision (other than by shave excision); and

(c) the specimen excised is sent for histological examination (Anaes.)

126.95

31216

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), removal of and suture, if:

(a) the lesion size is more than 20 mm in diameter; and

(b) the removal is from a mucous membrane by surgical excision (other than by shave excision); and

(c) the specimen excised is sent for histological examination (Anaes.)

148.05

31220

Tumours (other than viral verrucae (common warts) and seborrheic keratoses), cysts, ulcers or scars (other than scars removed during the surgical approach at an operation), removal of 4 to 10 lesions and suture, if:

(a) the size of each lesion is not more than 10 mm in diameter; and

(b) each removal is from cutaneous or subcutaneous tissue by surgical excision (other than by shave excision); and

(c) all of the specimens excised are sent for histological examination

(Anaes.)

221.25

31221

Tumours, cysts, ulcers or scars (other than scars removed during the surgical approach at an operation), removal of 4 to 10 lesions, if:

(a) the size of each lesion is not more than 10 mm in diameter; and

(b) each removal is from a mucous membrane by surgical excision (other than by shave excision); and

(c) each site of excision is closed by suture; and

(d) all of the specimens excised are sent for histological examination (Anaes.)

221.25

31225

Tumours (other than viral verrucae (common warts) and seborrheic keratoses), cysts, ulcers or scars (other than scars removed during the surgical approach at an operation), removal of more than 10 lesions, if:

(a) the size of each lesion is not more than 10 mm in diameter; and

(b) each removal is from cutaneous or subcutaneous tissue or mucous membrane by surgical excision (other than by shave excision); and

(c) each site of excision is closed by suture; and

(d) all of the specimens excised are sent for histological examination

(Anaes.)

393.20

31245

Skin and subcutaneous tissue, extensive excision of, in the treatment of suppurative hydradenitis (excision from axilla, groin or natal cleft) or sycosis barbae or nuchae (excision from face or neck) (Anaes.)

380.50

31250

Giant hairy or compound naevus, excision of an area at least 1% of body surface—if the specimen excised is sent for histological confirmation of diagnosis (Anaes.)

380.50

31340

Muscle, bone or cartilage, excision of one or more of, if clinically indicated, and if:

(a) the specimen excised is sent for histological confirmation; and

(b) a malignant tumour of skin covered by item 31000, 31001, 31002, 31003, 31004, 31005, 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371, 31372, 31373, 31374, 31375 or 31376 is excised

(Anaes.)

Amount under clause 5.10.2

31345

Lipoma, removal of, by surgical excision or liposuction, if:

(a) the lesion is:

(i) subcutaneous and 50 mm or more in diameter; or

(ii) subfascial; and

(b) the specimen excised is sent for histological confirmation of diagnosis

(Anaes.)

217.55

31346

Liposuction (suction assisted lipolysis) to one regional area for contour problems of abdominal, upper arm or thigh fat because of repeated insulin injections, if:

(a) the lesion is subcutaneous; and

(b) the lesion is 50 mm or more in diameter; and

(c) photographic and/or diagnostic imaging evidence demonstrating the need for this service is documented in the patient notes

(Anaes.)

217.55

31350

Benign tumour of soft tissue (other than tumours of skin, cartilage and bone, simple lipomas covered by item 31345 and lipomata), removal of, by surgical excision, on a person 10 years of age or over, if the specimen excised is sent for histological confirmation of diagnosis, other than a service to which another item in this Group applies (Anaes.) (Assist.)

446.90

31355

Malignant tumour of soft tissue (other than tumours of skin or cartilage and bone), removal of, by surgical excision, if histological proof of malignancy is obtained, other than a service to which another item in this Group applies (Anaes.) (Assist.)

736.80

31356

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b) the necessary excision diameter is less than 6 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

228.25

31357

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b) the necessary excision diameter is less than 6 mm; and

(c) the excised specimen is sent for histological examination;

not in association with item 45201 (Anaes.)

113.10

31358

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b) the necessary excision diameter is 6 mm or more; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

279.35

31359

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision), if:

(a) the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia (the applicable site); and

(b) the necessary excision area is at least one third of the surface area of the applicable site; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(H) (Anaes.)

340.50

31360

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b) the necessary excision diameter is 6 mm or more; and

(c) the excised specimen is sent for histological examination

(Anaes.)

173.30

31361

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from face, neck, scalp, nippleareola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b) the necessary excision diameter is less than 14 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

192.55

31362

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from face, neck, scalp, nippleareola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b) the necessary excision diameter is less than 14 mm; and

(c) the excised specimen is sent for histological examination;

not in association with item 45201 (Anaes.)

138.10

31363

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from face, neck, scalp, nippleareola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b) the necessary excision diameter is 14 mm or more; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

251.90

31364

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from face, neck, scalp, nippleareola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b) the necessary excision diameter is 14 mm or more; and

(c) the excised specimen is sent for histological examination

(Anaes.)

173.30

31365

Malignant skin lesion (other than a malignant skin lesion covered by item 31369, 31370, 31371, 31372 or 31373), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b) the necessary excision diameter is less than 15 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

163.25

31366

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from any part of the body not covered by item 31357, 31360, 31362 or 31364; and

(b) the necessary excision diameter is less than 15 mm; and

(c) the excised specimen is sent for histological examination;

not in association with item 45201 (Anaes.)

98.45

31367

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b) the necessary excision diameter is at least 15 mm but not more than 30 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

220.25

31368

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from any part of the body not covered by item 31357, 31360, 31362 or 31364; and

(b) the necessary excision diameter is at least 15 mm but not more than 30mm; and

(c) the excised specimen is sent for histological examination;

not in association with item 45201 (Anaes.)

129.45

31369

Malignant skin lesion (other than a malignant skin lesion covered by item 31371, 31372, 31373, 31374, 31375 or 31376), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from any part of the body not covered by item 31356, 31358, 31359, 31361 or 31363; and

(b) the necessary excision diameter is more than 30 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

253.60

31370

Nonmalignant skin lesion (other than viral verrucae (common warts) and seborrheic keratoses), including a cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), surgical excision (other than by shave excision) and repair of, if:

(a) the lesion is excised from any part of the body not covered by item 31357, 31360, 31362 or 31364; and

(b) the necessary excision diameter is more than 30 mm; and

(c) the excised specimen is sent for histological examination

(Anaes.)

148.05

31371

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, if:

(a) the tumour is excised from nose, eyelid, eyebrow, lip, ear, digit or genitalia, or from a contiguous area; and

(b) the necessary excision diameter is 6 mm or more; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

368.15

31372

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, if:

(a) the tumour is excised from face, neck, scalp, nippleareola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b) the necessary excision diameter is less than 14 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

318.35

31373

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, if:

(a) the tumour is excised from face, neck, scalp, nippleareola complex, distal lower limb (distal to, and including, the knee) or distal upper limb (distal to, and including, the ulnar styloid); and

(b) the necessary excision diameter is 14 mm or more; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

367.95

31374

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, if:

(a) the tumour is excised from any part of the body not covered by item 31371, 31372 or 31373; and

(b) the necessary excision diameter is less than 15 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

290.70

31375

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, if:

(a) the tumour is excised from any part of the body not covered by item 31371, 31372 or 31373; and

(b) the necessary excision diameter is at least 15 mm but not more than 30 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy;

not in association with item 45201 (Anaes.)

312.85

31376

Malignant melanoma, appendageal carcinoma, malignant connective tissue tumour of skin or merkel cell carcinoma of skin, definitive surgical excision (other than by shave excision) and repair of, if:

(a) the tumour is excised from any part of the body not covered by item 31371, 31372 or 31373; and

(b) the necessary excision diameter is more than 30 mm; and

(c) the excised specimen is sent for histological examination; and

(d) malignancy is confirmed from the excised specimen or previous biopsy

(Anaes.)

362.60

31400

Malignant upper aerodigestive tract tumour (other than tumour of the lip), excision of, if:

(a) the tumour is not more than 20 mm in diameter; and

(b) histological confirmation of malignancy is obtained

(Anaes.) (Assist.)

269.25

31403

Malignant upper aerodigestive tract tumour (other than tumour of the lip), excision of, if:

(a) the tumour is more than 20 mm but not more than 40 mm in diameter; and

(b) histological confirmation of malignancy is obtained

(H) (Anaes.) (Assist.)

310.75

31406

Malignant upper aerodigestive tract tumour more than 40 mm in diameter (excluding tumour of the lip), excision of, if histological confirmation of malignancy has been obtained (Anaes.) (Assist.)

517.85

31409

Parapharyngeal tumour, excision of, by cervical approach (H) (Anaes.) (Assist.)

1,608.90

31412

Recurrent or persistent parapharyngeal tumour, excision of, by cervical approach (H) (Anaes.) (Assist.)

1,981.80

31420

Lymph node of neck, biopsy of (Anaes.)

189.65

31423

Lymph nodes of neck, selective dissection of one or 2 lymph node levels involving removal of soft tissue and lymph nodes from one side of the neck, on a person 10 years of age or over (Anaes.) (Assist.)

414.30

31426

Lymph nodes of neck, selective dissection of 3 lymph node levels involving removal of soft tissue and lymph nodes from one side of the neck (H) (Anaes.) (Assist.)

828.55

31429

Lymph nodes of neck, selective dissection of 4 lymph node levels on one side of the neck with preservation of one or more of internal jugular vein, sternocleidomastoid muscle or spinal accessory nerve (H) (Anaes.) (Assist.)

1,291.25

31432

Lymph nodes of neck, bilateral selective dissection of levels I, II and III (bilateral supraomohyoid dissections) (H) (Anaes.) (Assist.)

1,381.00

31435

Lymph nodes of neck, comprehensive dissection of all 5 lymph node levels on one side of the neck (H) (Anaes.) (Assist.)

1,015.05

31438

Lymph nodes of neck, comprehensive dissection of all 5 lymph node levels on one side of the neck with preservation of one or more of internal jugular vein, sternocleidomastoid muscle, or spinal accessory nerve (H) (Anaes.) (Assist.)

1,608.90

31450

Laparoscopic division of adhesions, as an independent procedure, if the time taken is 1 hour or less (H) (Anaes.) (Assist.)

419.35

31452

Laparoscopic division of adhesions, as an independent procedure, if the time taken is more than 1 hour (H) (Anaes.) (Assist.)

733.75

31454

Laparoscopy with drainage of pus, bile or blood, as an independent procedure (H) (Anaes.) (Assist.)

580.90

31456

Gastroscopy and insertion of nasogastric or nasoenteral feeding tube, if blind insertion of the feeding tube has failed or is inappropriate due to the patient’s medical condition (H) (Anaes.)

253.25

31458

Gastroscopy and insertion of nasogastric or nasoenteral feeding tube if:

(a) blind insertion of the feeding tube has failed or is inappropriate due to the patient’s medical condition; and

(b) the use of imaging intensification is clinically indicated

(H) (Anaes.)

303.85

31460

Percutaneous gastrostomy tube, jejunal extension to, including any associated imaging services (H) (Anaes.) (Assist.)

368.15

31462

Operative feeding jejunostomy performed in conjunction with major upper gastrointestinal resection (H) (Anaes.) (Assist.)

537.55

31464

Antireflux operation by fundoplasty, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, by laparoscopic technique—other than a service to which item 30601 applies (H) (Anaes.) (Assist.)

898.55

31466

Antireflux operation by fundoplasty, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, revision procedure, by laparoscopy or open operation (H) (Anaes.) (Assist.)

1,347.75

31468

Paraoesophageal hiatus hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication (H) (Anaes.) (Assist.)

1,480.70

31470

Laparoscopic splenectomy, on a person 10 years of age or over (H) (Anaes.) (Assist.)

742.70

31472

Cholecystoduodenostomy, cholecystoenterostomy, choledochojejunostomy or Rouxeny as a bypass procedure, if prior biliary surgery has been performed (H) (Anaes.) (Assist.)

1,206.35

31500

Breast, benign lesion up to and including 50 mm in diameter, including simple cyst, fibroadenoma or fibrocystic disease, open surgical biopsy or excision of, with or without frozen section histology (Anaes.)

268.15

31503

Breast, benign lesion more than 50 mm in diameter, excision of (Anaes.) (Assist.)

357.60

31506

Breast, abnormality detected by mammography or ultrasound, if guidewire or other localisation procedure is performed, excision biopsy of (H) (Anaes.) (Assist.)

402.30

31509

Breast, malignant tumour, open surgical biopsy of, with or without frozen section histology (Anaes.)

357.60

31512

Breast, malignant tumour, complete local excision of, with or without frozen section histology (H) (Anaes.) (Assist.)

670.45

31515

Breast, tumour site, reexcision of, following open biopsy or incomplete excision of malignant tumour (H) (Anaes.) (Assist.)

449.80

31516

Breast, malignant tumour, complete local excision of, with or without frozen section histology when targeted intraoperative radiotherapy (using an intrabeam device) is performed concurrently, if the patient satisfies the requirements mentioned in paragraphs (a) to (g) of item 15900 (H) (Anaes.) (Assist.)

894.05

31519

Breast, total mastectomy (H) (Anaes.) (Assist.)

759.05

31524

Breast, subcutaneous mastectomy (H) (Anaes.) (Assist.)

1,072.75

31525

Breast, mastectomy for gynecomastia, with or without liposuction (suction assisted lipolysis), not being a service associated with a service to which item 45585 applies (H) (Anaes.) (Assist.)

536.20

31530

Breast, biopsy of solid tumour or tissue of, using a vacuumassisted breast biopsy device under imaging guidance, for histological examination, if imaging has demonstrated:

(a) microcalcification of lesion; or

(b) impalpable lesion less than one cm in diameter;

including preoperative localisation of lesion, if performed, other than a service associated with a service to which item 31548 applies

614.30

31533

Fine needle aspiration of an impalpable breast lesion detected by mammography or ultrasound, imaging guided—but not including imaging (Anaes.)

142.20

31536

Breast, preoperative localisation of lesion of, by hookwire or similar device, using interventional imaging techniques, but not including imaging (Anaes.)

195.35

31548

Breast, biopsy of solid tumour or tissue of, using mechanical biopsy device, for histological examination, other than a service associated with a service to which item 31530 applies (Anaes.)

206.25

31551

Breast, haematoma, seroma or inflammatory condition including abscess, granulomatous mastitis or similar, exploration and drainage of, when performed in the operating theatre of a hospital, excluding aftercare (H) (Anaes.)

223.50

31554

Breast, microdochotomy of, for benign or malignant condition (H) (Anaes.) (Assist.)

447.05

31557

Breast central ducts, excision of, for benign condition (Anaes.) (Assist.)

357.60

31560

Accessory breast tissue, excision of (Anaes.) (Assist.)

357.60

31563

Inverted nipple, surgical eversion of (Anaes.)

267.85

31566

Accessory nipple, excision of (Anaes.)

134.05

31569

Adjustable gastric band, placement of, with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (H) (Anaes.) (Assist.)

876.10

31572

Gastric bypass by RouxenY including associated anastomoses, with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity not being associated with a service to which item 30515 applies (H) (Anaes.) (Assist.)

1,078.10

31575

Sleeve gastrectomy, with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (H) (Anaes.) (Assist.)

876.10

31578

Gastroplasty (excluding by gastric plication), with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (H) (Anaes.) (Assist.)

876.10

31581

Gastric bypass by biliopancreatic diversion with or without duodenal switch including gastric restriction and anastomoses, with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (H) (Anaes.) (Assist.)

1,078.10

31584

Surgical reversal of adjustable gastric banding (removal or replacement of gastric band), gastric bypass, gastroplasty (excluding by gastric plication) or biliopancreatic diversion being services to which items 31569 to 31581 apply (H) (Anaes.) (Assist.)

1,587.20

31587

Adjustment of gastric band as an independent procedure including any associated consultation

101.00

31590

Adjustment of gastric band reservoir, repair, revision or replacement of (Anaes.) (Assist.)

259.60

 

Subdivision BSubgroups 2 and 3 of Group T8

5.10.10  Meaning of foreign body in items 35360 to 35363

  In items 35360 to 35363:

foreign body does not include an instrument inserted for the purpose of a service being rendered.

5.10.11  Application of items 32084 and 32087

  If a service to which item 32084 or 32087 applies is provided by a practitioner to a patient on more than one occasion on a day, the second service is taken to be a separate service for the purposes of the item if the second service is provided under a second episode of anaesthesia or other sedation.

5.10.12  Restrictions on items 32500 to 32517 and 35321—methods of providing services

  Items 32500 to 32517 and 35321 do not apply to the services described in those items if the services are delivered by:

 (a) endovenous laser treatment; or

 (b) radiofrequency diathermy; or

 (c) radiofrequency ablation for varicose veins.

5.10.13  Restrictions on items 35404, 35406 and 35408

Restriction connected with chemotherapy using certain drugs

 (1) Items 35404, 35406 and 35408 do not apply to selective internal radiation therapy provided in combination with systemic chemotherapy using any drugs other than 5 fluorouracil (5FU) and leucovorin.

Restriction on provider of service in item 35404

 (2) Item 35404 applies only to a service provided by a medical practitioner recognised as a specialist, or consultant physician, in the specialty of nuclear medicine or radiation oncology for the purposes of the Act.

5.10.14  When artificial bowel sphincter is contraindicated for items 32220 and 32221

  An artificial bowel sphincter under items 32220 and 32221 is contraindicated in:

 (a) patients with inflammatory bowel disease, pelvic sepsis, pregnancy, progressive degenerative diseases or a scarred or fragile perineum; and

 (b) patients who have had an adverse reaction to radiopaque solution; and

 (c) patients who engage in receptive anal intercourse.

5.10.15  Meaning of eligible stroke centre

  In this Schedule:

eligible stroke centre means a facility that:

 (a) has a designated stroke unit; and

 (b) is equipped and has staff available or on call so that it is capable of providing all of the following to a patient on a 24hour basis:

 (i) the services of a specialist or consultant physician who has the training required under paragraph (b) of item 35414;

 (ii) diagnostic imaging services using advanced imaging techniques, including computed tomography, computed tomography angiography, digital subtraction angiography, magnetic resonance imaging and magnetic resonance angiography;

 (iii) care from a team of health practitioners including a stroke physician, a neurologist, a neurosurgeon, a radiologist, an anaesthetist, an intensive care unit specialist, a medical imaging technologist and a nurse; and

 (c) has dedicated endovascular angiography facilities; and

 (d) has written procedures for assessing and treating patients who have, or may have, experienced a stroke.

Note: A health practitioner may fulfil the role of more than one of the types of health practitioner specified in paragraph (b)(iii). For example, a neurologist may also be a stroke physician.

5.10.16  Items in Subgroups 2 and 3 of Group T8

  This clause sets out items in Subgroups 2 and 3 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 2—Colorectal

32000

Large intestine, resection of, without anastomosis, including right hemicolectomy (including formation of stoma) (H) (Anaes.) (Assist.)

1,063.55

32003

Large intestine, resection of, with anastomosis, including right hemicolectomy (H) (Anaes.) (Assist.)

1,112.50

32004

Large intestine, subtotal colectomy (resection of right colon, transverse colon and splenic flexure) without anastomosis, other than a service associated with a service to which item 32000, 32003, 32005 or 32006 applies (H) (Anaes.) (Assist.)

1,186.30

32005

Large intestine, subtotal colectomy (resection of right colon, transverse colon and splenic flexure) with anastomosis, other than a service associated with a service to which item 32000, 32003, 32004 or 32006 applies (H) (Anaes.) (Assist.)

1,340.15

32006

Left hemicolectomy, including the descending and sigmoid colon (including formation of stoma) (H) (Anaes.) (Assist.)

1,186.30

32009

Total colectomy and ileostomy (H) (Anaes.) (Assist.)

1,407.25

32012

Total colectomy and ileorectal anastomosis (H) (Anaes.) (Assist.)

1,554.45

32015

Total colectomy with excision of rectum and ileostomy—one surgeon (H) (Anaes.) (Assist.)

1,910.40

32018

Total colectomy with excision of rectum and ileostomy, combined synchronous operation—abdominal resection (including aftercare) (H) (Anaes.) (Assist.)

1,619.95

32021

Total colectomy with excision of rectum and ileostomy, combined synchronous operation—perineal resection (H) (Assist.)

580.90

32023

Endoscopic insertion of stent or stents for large bowel obstruction, stricture or stenosis, including colonoscopy and any image intensification, if the obstruction is due to:

(a) a prediagnosed colorectal cancer, or cancer of an organ adjacent to the bowel; or

(b) an unknown diagnosis (H) (Anaes.)

572.70

32024

Rectum, high restorative anterior resection with intraperitoneal anastomosis (of the rectum) greater than 10 cm from the anal verge—excluding resection of sigmoid colon alone, other than a service associated with a service to which item 32103, 32104 or 32106 applies (H) (Anaes.) (Assist.)

1,407.25

32025

Rectum, low restorative anterior resection with extraperitoneal anastomosis (of the rectum) less than 10 cm from the anal verge, with or without covering stoma, other than a service associated with a service to which item 32103, 32104 or 32106 applies (H) (Anaes.) (Assist.)

1,882.30

32026

Rectum, ultra low restorative resection, with or without covering stoma, if the anastomosis is sited in the anorectal region and is 6 cm or less from the anal verge (H) (Anaes.) (Assist.)

2,027.05

32028

Rectum, low or ultra low restorative resection, with peranal sutured coloanal anastomosis, with or without covering stoma (H) (Anaes.) (Assist.)

2,172.00

32029

Colonic reservoir, construction of, being a service associated with a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

434.35

32030

Rectosigmoidectomy—(Hartmann’s operation) (H) (Anaes.) (Assist.)

1,063.55

32033

Restoration of bowel following Hartmann’s or similar operation, including dismantling of the stoma (H) (Anaes.) (Assist.)

1,554.45

32036

Sacrococcygeal and presacral tumour—excision of (H) (Anaes.) (Assist.)

1,971.55

32039

Rectum and anus, abdominoperineal resection of—one surgeon (H) (Anaes.) (Assist.)

1,583.00

32042

Rectum and anus, abdominoperineal resection of, combined synchronous operation, abdominal resection (H) (Anaes.) (Assist.)

1,333.55

32045

Rectum and anus, abdominoperineal resection of, combined synchronous operation—perineal resection (H) (Assist.)

499.10

32046

Rectum and anus, abdominoperineal resection of, combined synchronous operation—perineal resection if the perineal surgeon also provides assistance to the abdominal surgeon (H) (Assist.)

771.25

32047

Perineal proctectomy (H) (Anaes.) (Assist.)

898.55

32051

Total colectomy with excision of rectum and ileoanal anastomosis with formation of ileal reservoir, with or without creation of temporary ileostomy—one surgeon (H) (Anaes.) (Assist.)

2,388.95

32054

Total colectomy with excision of rectum and ileoanal anastomosis with formation of ileal reservoir, with or without creation of temporary ileostomy—conjoint surgery, abdominal surgeon (including aftercare) (H) (Anaes.) (Assist.)

2,192.60

32057

Total colectomy with excision of rectum and ileoanal anastomosis with formation of ileal reservoir—conjoint surgery, perineal surgeon (H) (Assist.)

580.90

32060

Ileostomy closure with rectal resection and mucosectomy and ileoanal anastomosis with formation of ileal reservoir, with or without temporary loop ileostomy—one surgeon (H) (Anaes.) (Assist.)

2,388.95

32063

Ileostomy closure with rectal resection and mucosectomy and ileoanal anastomosis with formation of ileal reservoir, with or without temporary loop ileostomy—conjoint surgery, abdominal surgeon (including aftercare) (H) (Anaes.) (Assist.)

2,192.60

32066

Ileostomy closure with rectal resection and mucosectomy and ileoanal anastomosis with formation of ileal reservoir, with or without temporary loop ileostomy—conjoint surgery, perineal surgeon (H) (Assist.)

580.90

32069

Ileostomy reservoir, continent type, creation of, including conversion of existing ileostomy, if appropriate (H) (Anaes.)

1,767.15

32072

Sigmoidoscopic examination (with rigid sigmoidoscope), with or without biopsy

49.35

32075

Sigmoidoscopic examination (with rigid sigmoidoscope), under general anaesthesia, with or without biopsy, other than a service associated with a service to which another item in this Group applies (Anaes.)

77.40

32084

Sigmoidoscopy or colonoscopy up to the hepatic flexure, with or without biopsy, other than a service associated with a service to which any of items 32222 to 32228 applies (Anaes.)

114.85

32087

Endoscopic examination of the colon up to the hepatic flexure by sigmoidoscopy or colonoscopy for the removal of one or more polyps, other than a service associated with a service to which any of items 32222 to 32228 applies (Anaes.)

211.10

32094

Endoscopic dilatation of colorectal strictures including colonoscopy (H) (Anaes.)

569.10

32095

Endoscopic examination of small bowel with flexible endoscope passed by stoma, with or without biopsies (Anaes.)

131.80

32096

Rectal biopsy, full thickness, under general anaesthesia, or under epidural or spinal (intrathecal) nerve block (H) (Anaes.) (Assist.)

264.95

32099

Rectal tumour of 5 cm or less in diameter, per anal submucosal excision of (H) (Anaes.) (Assist.)

343.65

32102

Rectal tumour of greater than 5 cm in diameter, indicated by pathological examination, per anal submucosal excision of (H) (Anaes.) (Assist.)

654.50

32103

Rectal tumour of less than 4 cm in diameter, per anal excision of, using rectoscopy incorporating either 2 dimensional or 3 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy or by local excision, other than a service associated with a service to which item 32024, 32025, 32104 or 32106 applies (H) (Anaes.) (Assist.)

796.40

32104

Rectal tumour of 4 cm or greater in diameter, per anal excision of, using rectoscopy incorporating either 2 dimensional or 3 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy or by local excision, other than a service associated with a service to which item 32024, 32025, 32103 or 32106 applies (H) (Anaes.) (Assist.)

1,030.90

32105

Anorectal carcinoma—per anal full thickness excision of (Anaes.) (Assist.)

499.10

32106

Anterolateral intraperitoneal rectal tumour, per anal excision of, using rectoscopy incorporating either 2 dimensional or 3 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy and if removal requires dissection within the peritoneal cavity, other than a service associated with a service to which item 32024, 32025, 32103 or 32104 applies (Anaes.) (Assist.)

1,407.25

32108

Rectal tumour, transsphincteric excision of (Kraske or similar operation) (H) (Anaes.) (Assist.)

1,030.90

32111

Rectal prolapse, Delorme procedure for (H) (Anaes.) (Assist.)

654.50

32112

Rectal prolapse, perineal rectosigmoidectomy for (H) (Anaes.) (Assist.)

796.40

32114

Rectal stricture, per anal release of (Anaes.)

179.90

32115

Rectal stricture, dilatation of (H) (Anaes.)

130.85

32117

Rectal prolapse, abdominal rectopexy of (H) (Anaes.) (Assist.)

1,030.90

32120

Rectal prolapse, perineal repair of (H) (Anaes.) (Assist.)

264.95

32123

Anal stricture, anoplasty for (Anaes.) (Assist.)

343.65

32126

Anal incontinence, Parks’ intersphincteric procedure for (H) (Anaes.) (Assist.)

499.10

32129

Anal sphincter, direct repair of (H) (Anaes.) (Assist.)

654.50

32131

Rectocele, transanal repair of rectocele (H) (Anaes.) (Assist.)

550.30

32132

Haemorrhoids or rectal prolapse—sclerotherapy for (Anaes.)

46.50

32135

Haemorrhoids or rectal prolapse—rubber band ligation of, with or without sclerotherapy, cryotherapy or infrared therapy for (Anaes.)

69.65

32138

Haemorrhoidectomy including excision of anal skin tags when performed (Anaes.)

379.25

32139

Haemorrhoidectomy involving third or fourth degree haemorrhoids, including excision of anal skin tags when performed (H) (Anaes.) (Assist.)

379.25

32142

Anal skin tags or anal polyps, excision of one or more of (Anaes.)

69.65

32145

Anal skin tags or anal polyps, excision of one or more of, undertaken in the operating theatre of a hospital (H) (Anaes.)

139.25

32147

Perianal thrombosis, incision of (Anaes.)

46.50

32150

Operation for fissureinano, including excision or sphincterotomy but excluding dilatation only (Anaes.) (Assist.)

264.95

32153

Anus, dilatation of, under general anaesthesia, with or without disimpaction of faeces, other than a service associated with a service to which another item in this Group applies (H) (Anaes.)

72.25

32156

Fistulainano, subcutaneous, excision of (Anaes.)

135.85

32159

Anal fistula, treatment of, by excision or by insertion of a Seton, or by a combination of both procedures, involving the lower half of the anal sphincter mechanism (H) (Anaes.) (Assist.)

343.65

32162

Anal fistula, treatment of, by excision or by insertion of a Seton, or by a combination of both procedures, involving the upper half of the anal sphincter mechanism (H) (Anaes.) (Assist.)

499.10

32165

Anal fistula, repair of by mucosal flap advancement (Anaes.) (Assist.)

654.50

32166

Anal fistula—readjustment of Seton (Anaes.)

212.65

32168

Fistula wound, review of, under general or regional anaesthetic, as an independent procedure (H) (Anaes.)

135.85

32171

Anorectal examination, with or without biopsy, under general anaesthetic, other than a service associated with a service to which another item in this Group applies (H) (Anaes.)

91.55

32174

Intraanal, perianal or ischiorectal abscess, drainage of (excluding aftercare) (Anaes.)

91.55

32175

Intraanal, perianal or ischiorectal abscess, draining of, performed in the operating theatre of a hospital (excluding aftercare) (H) (Anaes.)

167.75

32177

Anal warts, removal of, under general anaesthesia, or under regional or field nerve block (excluding pudendal block), if the time taken is less than or equal to 45 minutes—other than a service associated with a service to which item 35507 or 35508 applies (H) (Anaes.)

179.70

32180

Anal warts, removal of, under general anaesthesia, or under regional or field nerve block (excluding pudendal block), if the time taken is greater than 45 minutes—other than a service associated with a service to which item 35507 or 35508 applies (H) (Anaes.)

264.95

32183

Intestinal sling procedure before radiotherapy (H) (Anaes.) (Assist.)

579.20

32186

Colonic lavage, total, intraoperative (H) (Anaes.) (Assist.)

579.20

32200

Distal muscle, devascularisation of (Anaes.) (Assist.)

304.95

32203

Anal or perineal graciloplasty (H) (Anaes.) (Assist.)

654.85

32206

Stimulator and electrodes, insertion of, following previous graciloplasty (H) (Anaes.) (Assist.)

591.65

32209

Anal or perineal graciloplasty with insertion of stimulator and electrodes (H) (Anaes.) (Assist.)

950.75

32210

Gracilis neosphincter pacemaker, replacement of (Anaes.)

263.45

32212

Anorectal application of formalin in the treatment of radiation proctitis, if performed in the operating theatre of a hospital, excluding aftercare (H) (Anaes.)

140.55

32213

Sacral nerve lead or leads, percutaneous placement using fluoroscopic guidance (or open placement) and intraoperative test stimulation, to manage faecal incontinence in a patient who:

(a) has an anatomically intact but functionally deficient anal sphincter; and

(b) has faecal incontinence that has been refractory to conservative nonsurgical treatment for at least 12 months;

other than a patient who:

(c) is medically unfit for surgery; or

(d) is pregnant or planning pregnancy; or

(e) has irritable bowel syndrome; or

(f) has congenital anorectal malformations; or

(g) has active anal abscesses or fistulas; or

(h) has anorectal organic bowel disease, including cancer; or

(i) has functional effects of previous pelvic irradiation; or

(j) has congenital or acquired malformations of the sacrum; or

(k) has had rectal or anal surgery within the previous 12 months

(H) (Anaes.)

681.60

32214

Neurostimulator or receiver, subcutaneous placement of, involving placement and connection of an extension wire to a sacral nerve electrode using fluoroscopic guidance, to manage faecal incontinence in a patient who:

(a) has an anatomically intact but functionally deficient anal sphincter; and

(b) has faecal incontinence that has been refractory to conservative nonsurgical treatment for at least 12 months;

other than a patient who:

(c) is medically unfit for surgery; or

(d) is pregnant or planning pregnancy; or

(e) has irritable bowel syndrome; or

(f) has congenital anorectal malformations; or

(g) has active anal abscesses or fistulas; or

(h) has anorectal organic bowel disease, including cancer; or

(i) has functional effects of previous pelvic irradiation; or

(j) has congenital or acquired malformations of the sacrum; or

(k) has had rectal or anal surgery within the previous 12 months

(H) (Anaes.) (Assist.)

344.45

32215

Sacral nerve electrode or electrodes, management, adjustment and electronic programming of the neurostimulator by a medical practitioner, to manage faecal incontinence, other than in a patient who:

(a) is medically unfit for surgery; or

(b) is pregnant or planning pregnancy; or

(c) has irritable bowel syndrome; or

(d) has congenital anorectal malformations; or

(e) has active anal abscesses or fistulas; or

(f) has anorectal organic bowel disease, including cancer; or

(g) has functional effects of previous pelvic irradiation; or

(h) has congenital or acquired malformations of the sacrum; or

(i) has had rectal or anal surgery within the previous 12 months;

—each day

129.30

32216

Sacral nerve lead or leads, percutaneous surgical repositioning of, using fluoroscopic guidance (or open surgical repositioning of) and interoperative test stimulation, to correct displacement or unsatisfactory positioning, if the lead was inserted to manage faecal incontinence in a patient who:

(a) has an anatomically intact but functionally deficient anal sphincter; and

(b) has faecal incontinence that has been refractory to conservative nonsurgical treatment for at least 12 months;

other than a patient who:

(c) is medically unfit for surgery; or

(d) is pregnant or planning pregnancy; or

(e) has irritable bowel syndrome; or

(f) has congenital anorectal malformations; or

(g) has active anal abscesses or fistulas; or

(h) has anorectal organic bowel disease, including cancer; or

(i) has functional effects of previous pelvic irradiation; or

(j) has congenital or acquired malformations of the sacrum; or

(k) has had rectal or anal surgery within the previous 12 months;

other than a service to which item 32213 applies (H) (Anaes.)

612.10

32217

Neurostimulator or receiver, removal of, if the neurostimulator or receiver was inserted to manage faecal incontinence in a patient who:

(a) has an anatomically intact but functionally deficient anal sphincter; and

(b) has faecal incontinence that has been refractory to conservative nonsurgical treatment for at least 12 months;

other than a patient who:

(c) is medically unfit for surgery; or

(d) is pregnant or planning pregnancy; or

(e) has irritable bowel syndrome; or

(f) has congenital anorectal malformations; or

(g) has active anal abscesses or fistulas; or

(h) has anorectal organic bowel disease, including cancer; or

(i) has functional effects of previous pelvic irradiation; or

(j) has congenital or acquired malformations of the sacrum; or

(k) has had rectal or anal surgery within the previous 12 months

(H) (Anaes.)

161.20

32218

Sacral nerve lead or leads, removal of, if the lead was inserted to manage faecal incontinence in a patient who:

(a) has an anatomically intact but functionally deficient anal sphincter; and

(b) has faecal incontinence that has been refractory to conservative nonsurgical treatment for at least 12 months;

other than a patient who:

(c) is medically unfit for surgery; or

(d) is pregnant or planning pregnancy; or

(e) has irritable bowel syndrome; or

(f) has congenital anorectal malformations; or

(g) has active anal abscesses or fistulas; or

(h) has anorectal organic bowel disease, including cancer; or

(i) has functional effects of previous pelvic irradiation; or

(j) has congenital or acquired malformations of the sacrum; or

(k) has had rectal or anal surgery within the previous 12 months

(H) (Anaes.)

161.20

32220

Insertion of an artificial bowel sphincter for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist.)

932.15

32221

Removal or revision of an artificial bowel sphincter (with or without replacement) for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist.)

932.15

32222

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) following a positive faecal occult blood test; or

(b) who has symptoms consistent with pathology of the colonic mucosa; or

(c) who has anaemia or iron deficiency; or

(d) for whom diagnostic imaging has shown an abnormality of the colon; or

(e) who is undergoing the first examination following surgery for colorectal cancer; or

(f) who is undergoing preoperative evaluation; or

(g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(h) for the management of inflammatory bowel disease

Applicable only once on a day under a single episode of anaesthesia or other sedation (Anaes.)

344.80

32223

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) who has had a colonoscopy that revealed 1 to 4 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(b) who has a moderate risk of colorectal cancer due to family history; or

(c) who has a history of colorectal cancer and has had an initial postoperative colonoscopy that did not reveal any adenomas or colorectal cancer

Applicable only once in any 5year period (Anaes.)

344.80

32224

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a moderate risk of colorectal cancer due to:

(a) a history of adenomas, including an adenoma that:

(i) was 10 mm or greater in diameter; or

(ii) had villous features; or

(iii) had high grade dysplasia; or

(iv) was an advanced serrated adenoma; or

(b) having had a previous colonoscopy that revealed 5 to 9 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia

Applicable only once in any 3year period (Anaes.)

344.80

32225

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to having had a previous colonoscopy that:

(a) revealed 10 or more adenomas; or

(b) included a piecemeal, or possibly incomplete, excision of a large, sessile polyp

Applicable not more than 4 times in any 12month period (Anaes.)

344.80

32226

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to:

(a) a known or suspected familial condition, such as familial adenomatous polyposis, Lynch syndrome or serrated polyposis syndrome; or

(b) a genetic mutation associated with hereditary colorectal cancer

Applicable only once in any 12month period (Anaes.)

344.80

32227

Endoscopic examination of the colon to the caecum by colonoscopy:

(a) for the treatment of bleeding, including one or more of the following:

(i) radiation proctitis;

(ii) angioectasia;

(iii) postpolypectomy bleeding; or

(b) for the treatment of colonic strictures with balloon dilatation

Applicable only once on a day under a single episode of anaesthesia or other sedation (Anaes.)

483.85

32228

Endoscopic examination of the colon to the caecum by colonoscopy, other than a service to which item 32222, 32223, 32224, 32225 or 32226 applies

Applicable only once (Anaes.)

344.80

32229

Removal of one or more polyps during colonoscopy, in association with a service to which item 32222, 32223, 32224, 32225, 32226 or 32228 applies (Anaes.)

278.10

Subgroup 3—Vascular

32500

Varicose veins if varicosity measures 2.5 mm or greater in diameter, multiple injections of sclerosant using continuous compression techniques, including associated consultation—one or both legs—other than a service associated with another varicose vein operation on the same leg (excluding aftercare)—to a maximum of 6 treatments in a 12 month period (Anaes.)

113.20

32504

Varicose veins, multiple excision of tributaries, with or without division of one or more perforating veins—one leg—other than a service associated with a service to which item 32507, 32508, 32511, 32514 or 32517 applies in relation to the same leg (Anaes.)

276.05

32507

Varicose veins, subfascial surgical exploration of one or more incompetent perforating veins—one leg—other than a service associated with a service to which item 32508, 32511, 32514 or 32517 applies in relation to the same leg (Anaes.) (Assist.)

550.30

32508

Varicose veins, complete dissection at the saphenofemoral junction or saphenopopliteal junction—one leg—with or without either ligation or stripping, or both, of the long or short saphenous vein on the same leg, for the first time, including excision or injection of either tributaries or incompetent perforating veins, or both (H) (Anaes.) (Assist.)

550.30

32511

Varicose veins, complete dissection at the saphenofemoral junction and saphenopopliteal junction—one leg—with or without either ligation or stripping, or both, of the long or short saphenous vein on the same leg, for the first time, including excision or injection of either tributaries or incompetent perforating veins, or both (H) (Anaes.) (Assist.)

818.10

32514

Varicose veins, ligation of the long or short saphenous vein on the same leg, with or without stripping, by reoperation for recurrent veins in the same territory—one leg—including excision or injection of either tributaries or incompetent perforating veins, or both (H) (Anaes.) (Assist.)

955.75

32517

Varicose veins, ligation of the long and short saphenous veins on the same leg, with or without stripping, by reoperation for recurrent veins in either territory—one leg—including excision or injection of either tributaries or incompetent perforating veins, or both (H) (Anaes.) (Assist.)

1,230.70

32520

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great (long) or small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using a laser probe introduced by an endovenous catheter, if it is documented by duplex ultrasound that the great or small saphenous vein (whichever is to be treated) demonstrates reflux of 0.5 seconds or longer:

(a) including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both); and

(b) not including radiofrequency diathermy, radiofrequency ablation or cyanoacrylate embolisation; and

(c) not provided on the same occasion as a service described in any of items 32500, 32504 and 32507

(Anaes.)

550.30

32522

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great (long) and small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using a laser probe introduced by an endovenous catheter, if it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer:

(a) including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both); and

(b) not including radiofrequency diathermy, radiofrequency ablation or cyanoacrylate embolisation; and

(c) not provided on the same occasion as a service described in any of items 32500, 32504 and 32507

(Anaes.)

818.10

32523

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great (long) or small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using a radiofrequency catheter introduced by an endovenous catheter, if it is documented by duplex ultrasound that the great or small saphenous vein (whichever is to be treated) demonstrates reflux of 0.5 seconds or longer:

(a) including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both); and

(b) not including endovenous laser therapy or cyanoacrylate embolisation; and

(c) not provided on the same occasion as a service described in any of items 32500, 32504 and 32507

(Anaes.)

550.30

32526

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great (long) and small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using a radiofrequency catheter introduced by an endovenous catheter, if it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer:

(a) including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both); and

(b) not including endovenous laser therapy or cyanoacrylate embolisation; and

(c) not provided on the same occasion as a service described in any of items 32500, 32504 and 32507

(Anaes.)

818.10

32528

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great (long) or small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using cyanoacrylate adhesive, if it is documented by duplex ultrasound that the great or small saphenous vein (whichever is to be treated) demonstrates reflux of 0.5 seconds or longer:

(a) including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both); and

(b) not including radiofrequency diathermy, radiofrequency ablation or endovenous laser therapy; and

(c) not provided on the same occasion as a service described in any of items 32500, 32504 and 32507

(Anaes.)

550.30

32529

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great (long) and small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using cyanoacrylate adhesive, if it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer:

(a) including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both); and

(b) not including radiofrequency diathermy, radiofrequency ablation or endovenous laser therapy; and

(c) not provided on the same occasion as a service described in any of items 32500, 32504 and 32507

(Anaes.)

818.10

32700

Artery of neck, bypass using vein or synthetic material (H) (Anaes.) (Assist.)

1,481.20

32703

Internal carotid artery, transection and reanastomosis of, or resection of small length and reanastomosis of—with or without endarterectomy (H) (Assist.)

1,225.30

32708

Aortic bypass for occlusive disease using a straight nonbifurcated graft (H) (Anaes.) (Assist.)

1,465.75

32710

Aortic bypass for occlusive disease using a bifurcated graft with one or both anastomoses to the iliac arteries (H) (Anaes.) (Assist.)

1,628.60

32711

Aortic bypass for occlusive disease using a bifurcated graft with one or both anastomoses to the common femoral or profunda femoris arteries (H) (Anaes.) (Assist.)

1,791.55

32712

Iliofemoral bypass grafting (H) (Anaes.) (Assist.)

1,295.05

32715

Axillary or subclavian to femoral bypass grafting to one or both femoral arteries (H) (Anaes.) (Assist.)

1,295.05

32718

Femorofemoral or iliofemoral crossover bypass grafting (H) (Anaes.) (Assist.)

1,225.30

32721

Renal artery, bypass grafting to (H) (Anaes.) (Assist.)

1,946.30

32724

Renal arteries (both), bypass grafting to (H) (Anaes.) (Assist.)

2,210.05

32730

Mesenteric vessel (single), bypass grafting to (H) (Anaes.) (Assist.)

1,675.05

32733

Mesenteric vessels (multiple), bypass grafting to (H) (Anaes.) (Assist.)

1,946.30

32736

Inferior mesenteric artery, operation on, when performed in conjunction with another intraabdominal vascular operation (H) (Anaes.) (Assist.)

426.45

32739

Femoral artery bypass grafting using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with above knee anastomosis (H) (Anaes.) (Assist.)

1,333.80

32742

Femoral artery bypass grafting using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with distal anastomosis to below knee popliteal artery (H) (Anaes.) (Assist.)

1,527.80

32745

Femoral artery bypass grafting using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with distal anastomosis to tibio peroneal trunk or tibial or peroneal artery (H) (Anaes.) (Assist.)

1,744.80

32748

Femoral artery bypass grafting using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with distal anastomosis within 5 cm of the ankle joint (H) (Anaes.) (Assist.)

1,892.10

32751

Femoral artery bypass grafting using synthetic graft, with lower anastomosis above or below the knee (H) (Anaes.) (Assist.)

1,225.30

32754

Femoral artery bypass grafting, using a composite graft (synthetic material and vein) with lower anastomosis above or below the knee, including use of a cuff or sleeve of vein at one or both anastomoses (H) (Anaes.) (Assist.)

1,527.80

32757

Femoral artery sequential bypass grafting (using a vein or synthetic material) if an additional anastomosis is made to separately revascularise more than one artery—each additional artery revascularised beyond a femoral bypass (H) (Anaes.) (Assist.)

426.45

32760

Vein, harvesting of, from leg or arm for bypass or replacement graft when not performed on the limb which is the subject of the bypass or graft—each vein (H) (Anaes.) (Assist.)

418.75

32763

Arterial bypass grafting, using vein or synthetic material, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

1,225.30

32766

Arterial or venous anastomosis, other than a service to which another item in this Subgroup applies, as an independent procedure (H) (Anaes.) (Assist.)

814.35

32769

Arterial or venous anastomosis other than a service to which another item in this Subgroup applies, when performed in combination with another vascular operation (including graft to graft anastomosis) (H) (Anaes.) (Assist.)

282.20

33050

Bypass grafting to replace a popliteal aneurysm using vein, including harvesting vein (when it is the ipsilateral long saphenous vein) (H) (Anaes.) (Assist.)

1,500.80

33055

Bypass grafting to replace a popliteal aneurysm using a synthetic graft (H) (Anaes.) (Assist.)

1,203.50

33070

Aneurysm in the extremities, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)

868.30

33075

Aneurysm in the neck, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)

1,104.50

33080

Intraabdominal or pelvic aneurysm, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)

1,348.30

33100

Aneurysm of common or internal carotid artery, or both, replacement by graft of vein or synthetic material (Anaes.) (Assist.)

1,481.20

33103

Thoracic aneurysm, replacement by graft (H) (Anaes.) (Assist.)

2,078.25

33109

Thoracoabdominal aneurysm, replacement by graft including reimplantation of arteries (Anaes.) (Assist.)

2,512.65

33112

Suprarenal abdominal aortic aneurysm, replacement by graft including reimplantation of arteries (H) (Anaes.) (Assist.)

2,179.10

33115

Infrarenal abdominal aortic aneurysm, replacement by tube graft other than a service associated with a service to which item 33116 applies (H) (Anaes.) (Assist.)

1,465.75

33116

Infrarenal abdominal aortic aneurysm (repair), replacement by tube graft using endovascular repair procedure, excluding associated radiological services (Anaes.) (Assist.)

1,442.70

33118

Infrarenal abdominal aortic aneurysm, replacement by bifurcation graft to iliac arteries (with or without excision of common iliac aneurysms) other than a service associated with a service to which item 33119 applies (H) (Anaes.) (Assist.)

1,628.60

33119

Infrarenal abdominal aortic aneurysm (repair), replacement by bifurcation graft to one or both iliac arteries using endovascular repair procedure, excluding associated radiological services (Anaes.) (Assist.)

1,603.10

33121

Infrarenal abdominal aortic aneurysm, replacement by bifurcation graft to one or both femoral arteries (with or without excision or bypass of common iliac aneurysms) (H) (Anaes.) (Assist.)

1,791.55

33124

Aneurysm of iliac artery (common, external or internal), replacement by graft—unilateral (H) (Anaes.) (Assist.)

1,248.60

33127

Aneurysms of iliac arteries (common, external or internal), replacement by graft—bilateral (Anaes.) (Assist.)

1,636.35

33130

Aneurysm of visceral artery, excision and repair by direct anastomosis or replacement by graft (H) (Anaes.) (Assist.)

1,426.90

33133

Aneurysm of visceral artery, dissection and ligation of arteries without restoration of continuity (H) (Anaes.) (Assist.)

1,070.05

33136

False aneurysm, repair of, at aortic anastomosis following previous aortic surgery (H) (Anaes.) (Assist.)

2,698.50

33139

False aneurysm, repair of, in iliac artery and restoration of arterial continuity (H) (Anaes.) (Assist.)

1,636.35

33142

False aneurysm, repair of, in femoral artery and restoration of arterial continuity (Anaes.) (Assist.)

1,527.80

33145

Ruptured thoracic aortic aneurysm, replacement by graft (H) (Anaes.) (Assist.)

2,628.85

33148

Ruptured thoracoabdominal aortic aneurysm, replacement by graft (H) (Anaes.) (Assist.)

3,264.70

33151

Ruptured suprarenal abdominal aortic aneurysm, replacement by graft (H) (Anaes.) (Assist.)

3,101.90

33154

Ruptured infrarenal abdominal aortic aneurysm, replacement by tube graft (H) (Anaes.) (Assist.)

2,295.40

33157

Ruptured infrarenal abdominal aortic aneurysm, replacement by bifurcation graft to iliac arteries (with or without excision or bypass of common iliac aneurysms) (H) (Anaes.) (Assist.)

2,559.00

33160

Ruptured infrarenal abdominal aortic aneurysm, replacement by bifurcation graft to one or both femoral arteries (H) (Anaes.) (Assist.)

2,559.00

33163

Ruptured iliac artery aneurysm, replacement by graft (H) (Anaes.) (Assist.)

2,171.50

33166

Ruptured aneurysm of visceral artery, replacement by anastomosis or graft (Anaes.) (Assist.)

2,171.50

33169

Ruptured aneurysm of visceral artery, simple ligation of (H) (Anaes.) (Assist.)

1,690.60

33172

Aneurysm of major artery, replacement by graft, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

1,318.30

33175

Ruptured aneurysm in the extremities, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)

1,214.90

33178

Ruptured aneurysm in the neck, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)

1,545.00

33181

Ruptured intraabdominal or pelvic aneurysm, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)

1,888.90

33500

Artery or arteries of neck, endarterectomy of, including closure by suture (if endarterectomy of one or more arteries is undertaken through one arteriotomy incision) (H) (Anaes.) (Assist.)

1,170.85

33506

Innominate or subclavian artery, endarterectomy of, including closure by suture (H) (Anaes.) (Assist.)

1,310.60

33509

Aortic endarterectomy, including closure by suture, other than a service associated with another procedure on the aorta (H) (Anaes.) (Assist.)

1,465.75

33512

Aortoiliac endarterectomy (one or both iliac arteries), including closure by suture other than a service associated with a service to which item 33515 applies (H) (Anaes.) (Assist.)

1,628.60

33515

Aortofemoral endarterectomy (one or both femoral arteries) or bilateral iliofemoral endarterectomy, including closure by suture, other than a service associated with a service to which item 33512 applies (H) (Anaes.) (Assist.)

1,791.55

33518

Iliac endarterectomy, including closure by suture, other than a service associated with another procedure on the iliac artery (Anaes.) (Assist.)

1,310.60

33521

Iliofemoral endarterectomy (one side), including closure by suture (H) (Anaes.) (Assist.)

1,419.05

33524

Renal artery, endarterectomy of (H) (Anaes.) (Assist.)

1,675.05

33527

Renal arteries (both), endarterectomy of (H) (Anaes.) (Assist.)

1,946.30

33530

Coeliac or superior mesenteric artery, endarterectomy of (H) (Anaes.) (Assist.)

1,675.05

33533

Coeliac and superior mesenteric artery, endarterectomy of (H) (Anaes.) (Assist.)

1,946.30

33536

Inferior mesenteric artery, endarterectomy of, other than a service associated with a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

1,388.15

33539

Artery of extremities, endarterectomy of, including closure by suture (H) (Anaes.) (Assist.)

1,000.35

33542

Extended deep femoral endarterectomy, if the endarterectomy is at least 7 cm long (H) (Anaes.) (Assist.)

1,426.90

33545

Artery, vein or bypass graft, patch grafting to by vein or synthetic material if patch is less than 3 cm long (H) (Anaes.) (Assist.)

282.20

33548

Artery, vein or bypass graft, patch grafting to by vein or synthetic material if patch is 3 cm long or greater (H) (Anaes.) (Assist.)

574.00

33551

Vein, harvesting of from leg or arm for patch when not performed through same incision as operation (H) (Anaes.) (Assist.)

282.20

33554

Endarterectomy, in conjunction with an arterial bypass operation to prepare the site for anastomosis—each site (H) (Anaes.) (Assist.)

280.90

33800

Embolus, removal of, from artery of neck (Anaes.) (Assist.)

1,217.50

33803

Embolectomy or thrombectomy, by abdominal approach, of an artery or bypass graft of trunk (H) (Anaes.) (Assist.)

1,163.30

33806

Embolectomy or thrombectomy (including the infusion of thrombolytic or other agents) from an artery or bypass graft of extremities, or embolectomy of abdominal artery via the femoral artery, item to be claimed once per extremity, regardless of the number of incisions required to access the artery or bypass graft (Anaes.) (Assist.)

837.55

33810

Inferior vena cava or iliac vein, closed thrombectomy by catheter via the femoral vein (Anaes.) (Assist.)

611.00

33811

Inferior vena cava or iliac vein, open removal of thrombus or tumour (H) (Anaes.) (Assist.)

1,818.90

33812

Thrombus, removal of, from femoral or other similar large vein (Anaes.) (Assist.)

961.55

33815

Major artery or vein of extremity, repair of wound of, with restoration of continuity, by lateral suture (H) (Anaes.) (Assist.)

884.05

33818

Major artery or vein of extremity, repair of wound of, with restoration of continuity, by direct anastomosis (H) (Anaes.) (Assist.)

1,031.40

33821

Major artery or vein of extremity, repair of wound of, with restoration of continuity, by interposition graft of synthetic material or vein (H) (Anaes.) (Assist.)

1,178.70

33824

Major artery or vein of neck, repair of wound of, with restoration of continuity, by lateral suture (H) (Anaes.) (Assist.)

1,124.40

33827

Major artery or vein of neck, repair of wound of, with restoration of continuity, by direct anastomosis (H) (Anaes.) (Assist.)

1,318.30

33830

Major artery or vein of neck, repair of wound of, with restoration of continuity, by interposition graft of synthetic material or vein (H) (Anaes.) (Assist.)

1,512.10

33833

Major artery or vein of abdomen, repair of wound of, with restoration of continuity by lateral suture (H) (Anaes.) (Assist.)

1,372.75

33836

Major artery or vein of abdomen, repair of wound of, with restoration of continuity by direct anastomosis (H) (Anaes.) (Assist.)

1,636.35

33839

Major artery or vein of abdomen, repair of wound of, with restoration of continuity by means of interposition graft (H) (Anaes.) (Assist.)

1,915.40

33842

Artery of neck, reoperation for bleeding or thrombosis after carotid or vertebral artery surgery (H) (Anaes.) (Assist.)

946.10

33845

Laparotomy for control of postoperative bleeding or thrombosis after intraabdominal vascular procedure, if no other procedure is performed (H) (Anaes.) (Assist.)

659.20

33848

Extremity, reoperation on, for control of bleeding or thrombosis after vascular procedure, if no other procedure is performed (H) (Anaes.) (Assist.)

659.20

34100

Major artery of neck, elective ligation or exploration of, other than a service associated with another vascular procedure (H) (Anaes.) (Assist.)

729.05

34103

Great artery (aorta or pulmonary artery) or great vein (superior or inferior vena cava), ligation or exploration of immediate branches or tributaries, or ligation or exploration of the subclavian, axillary, iliac, femoral or popliteal arteries or veins, if the service is not associated with item 32508, 32511, 32520, 32522, 32523, 32526, 32528 or 32529—for a maximum of 2 services provided to the same patient on the same occasion (H) (Anaes.) (Assist.)

426.45

34106

Artery or vein (including brachial, radial, ulnar or tibial), ligation of, by elective operation, or exploration of, other than a service associated with another vascular procedure except those services to which item 32508, 32511, 32514 or 32517 applies (Anaes.) (Assist.)

300.80

34109

Temporal artery, biopsy of (Anaes.) (Assist.)

348.90

34112

Arteriovenous fistula of an extremity, dissection and ligation (H) (Anaes.) (Assist.)

884.05

34115

Arteriovenous fistula of the neck, dissection and ligation (H) (Anaes.) (Assist.)

1,000.35

34118

Arteriovenous fistula of the abdomen, dissection and ligation (Anaes.) (Assist.)

1,426.90

34121

Arteriovenous fistula of an extremity, dissection and repair of, with restoration of continuity (H) (Anaes.) (Assist.)

1,139.90

34124

Arteriovenous fistula of the neck, dissection and repair of, with restoration of continuity (H) (Anaes.) (Assist.)

1,248.60

34127

Arteriovenous fistula of the abdomen, dissection and repair of, with restoration of continuity (H) (Anaes.) (Assist.)

1,636.35

34130

Surgically created arteriovenous fistula of an extremity, closure of (Anaes.) (Assist.)

511.80

34133

Scalenotomy (H) (Anaes.) (Assist.)

574.00

34136

First rib, resection of portion of (H) (Anaes.) (Assist.)

922.70

34139

Cervical rib, removal of, or other operation for removal of thoracic outlet compression, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

922.70

34142

Coeliac artery, decompression of, for coeliac artery compression syndrome, as an independent procedure (H) (Anaes.) (Assist.)

1,139.90

34145

Popliteal artery, exploration of, for popliteal entrapment, with or without division of fibrous tissue and muscle (H) (Anaes.) (Assist.)

829.75

34148

Carotid associated tumour, resection of, with or without repair or reconstruction of internal or common carotid arteries, when tumour is 4 cm or less in maximum diameter (H) (Anaes.) (Assist.)

1,481.20

34151

Carotid associated tumour, resection of, with or without repair or reconstruction of internal or common carotid arteries, when tumour is greater than 4 cm in maximum diameter (H) (Anaes.) (Assist.)

2,023.95

34154

Recurrent carotid associated tumour, resection of, with or without repair or replacement of portion of internal or common carotid arteries (Anaes.) (Assist.)

2,411.80

34157

Neck, excision of infected bypass graft, including closure of vessel or vessels (H) (Anaes.) (Assist.)

1,225.30

34160

Aortoduodenal fistula, repair of, by suture of aorta and repair of duodenum (H) (Anaes.) (Assist.)

2,295.40

34163

Aortoduodenal fistula, repair of, by insertion of aortic graft and repair of duodenum (H) (Anaes.) (Assist.)

2,946.80

34166

Aortoduodenal fistula, repair of, by oversewing of abdominal aorta, repair of duodenum and axillo bifemoral grafting (H) (Anaes.) (Assist.)

2,946.80

34169

Infected bypass graft from trunk, excision of, including closure of arteries (H) (Anaes.) (Assist.)

1,636.35

34172

Infected axillofemoral or femorofemoral graft, excision of, including closure of arteries (H) (Anaes.) (Assist.)

1,333.80

34175

Infected bypass graft from extremities, excision of including closure of arteries (H) (Anaes.) (Assist.)

1,225.30

34500

Arteriovenous shunt, external, insertion of (Anaes.) (Assist.)

318.05

34503

Arteriovenous anastomosis of upper or lower limb, in conjunction with another venous or arterial operation (H) (Anaes.) (Assist.)

426.45

34506

Arteriovenous shunt, external, removal of (H) (Anaes.) (Assist.)

217.00

34509

Arteriovenous anastomosis of upper or lower limb, not in conjunction with another venous or arterial operation (H) (Anaes.) (Assist.)

1,008.10

34512

Arteriovenous access device, insertion of (H) (Anaes.) (Assist.)

1,109.00

34515

Arteriovenous access device, thrombectomy of (H) (Anaes.) (Assist.)

790.95

34518

Stenosis of arteriovenous fistula or prosthetic arteriovenous access device, correction of (H) (Anaes.) (Assist.)

1,325.90

34521

Intraabdominal artery or vein, cannulation of, for infusion chemotherapy, by open operation (excluding aftercare) (H) (Anaes.) (Assist.)

814.65

34524

Arterial cannulation for infusion chemotherapy by open operation, other than a service to which item 34521 applies (excluding aftercare) (H) (Anaes.) (Assist.)

426.45

34527

Central vein catheterisation by open technique, using subcutaneous tunnel with pump or access port as with central venous line catheter or other chemotherapy delivery device, including any associated percutaneous central vein catheterisation, on a person 10 years of age or over (Anaes.)

568.85

34528

Central vein catheterisation by percutaneous technique, using subcutaneous tunnel with pump or access port as with central venous line catheter or other chemotherapy delivery device, on a person 10 years of age or over (Anaes.)

280.90

34529

Central vein catheterisation by open technique, using subcutaneous tunnel with pump or access port as with central venous line catheter or other chemotherapy delivery device, including any associated percutaneous central vein catheterisation, on a person under 10 years of age (Anaes.)

739.50

34530

Central venous line, or other chemotherapy device, removal of, by open surgical procedure in the operating theatre of a hospital, on a person 10 years of age or over (Anaes.)

210.60

34533

Isolated limb perfusion, including cannulation of artery and vein at commencement of procedure, regional perfusion for chemotherapy, or other therapy, repair of arteriotomy and venotomy at conclusion of procedure (excluding aftercare) (Anaes.) (Assist.)

1,279.40

34534

Central vein catheterisation by percutaneous technique, using subcutaneous tunnel with pump or access port as with central venous line catheter or other chemotherapy delivery device, on a person under 10 years of age (Anaes.)

365.15

34538

Central vein catheterisation by percutaneous technique, using subcutaneous tunnelled cuffed catheter or similar device, for the administration of haemodialysis or parenteral nutrition (Anaes.)

280.90

34539

Tunnelled cuffed catheter, or similar device, removal of, by open surgical procedure (Anaes.)

210.60

34540

Central venous line, or other chemotherapy device, removal of, by open surgical procedure in the operating theatre of a hospital, on a person under 10 years of age (Anaes.)

273.80

34800

Inferior vena cava, plication, ligation, or application of caval clip (Anaes.) (Assist.)

837.55

34803

Inferior vena cava, reconstruction of or bypass by vein or synthetic material (H) (Anaes.) (Assist.)

1,845.80

34806

Cross leg bypass grafting, saphenous to iliac or femoral vein (H) (Anaes.) (Assist.)

1,000.35

34809

Saphenous vein anastomosis to femoral or popliteal vein for femoral vein bypass (H) (Anaes.) (Assist.)

1,000.35

34812

Venous stenosis or occlusion, vein bypass for, using vein or synthetic material, other than a service associated with a service to which item 34806 or 34809 applies (H) (Anaes.) (Assist.)

1,209.70

34815

Vein stenosis, patch angioplasty for, (excluding vein graft stenosis)—using vein or synthetic material (H) (Anaes.) (Assist.)

1,000.35

34818

Venous valve, plication or repair to restore valve competency (H) (Anaes.) (Assist.)

1,101.15

34821

Vein transplant to restore valvular function (Anaes.) (Assist.)

1,496.75

34824

External stent, application of, to restore venous valve competency to superficial vein—one stent (H) (Anaes.) (Assist.)

511.80

34827

External stents, application of, to restore venous valve competency to superficial vein or veins—more than one stent (H) (Anaes.) (Assist.)

620.45

34830

External stent, application of, to restore venous valve competency to deep vein—one stent (Anaes.) (Assist.)

729.05

34833

External stents, application of, to restore venous valve competency to deep vein or veins—more than one stent (H) (Anaes.) (Assist.)

946.10

35000

Lumbar sympathectomy (Anaes.) (Assist.)

729.05

35003

Cervical or upper thoracic sympathectomy by any surgical approach (H) (Anaes.) (Assist.)

946.10

35006

Cervical or upper thoracic sympathectomy, if operation is a reoperation for previous incomplete sympathectomy by any surgical approach (H) (Anaes.) (Assist.)

1,186.50

35009

Lumbar sympathectomy, if operation is following chemical sympathectomy or for previous incomplete surgical sympathectomy (H) (Anaes.) (Assist.)

922.70

35012

Sacral or presacral sympathectomy (H) (Anaes.) (Assist.)

729.05

35100

Ischaemic limb, debridement of necrotic material, gangrenous tissue, or slough in, in the operating theatre of a hospital, when debridement includes muscle, tendon or bone (H) (Anaes.) (Assist.)

380.05

35103

Ischaemic limb, debridement of necrotic material, gangrenous tissue, or slough in, in the operating theatre of a hospital, superficial tissue only (H) (Anaes.)

241.85

35200

Operative arteriography or venography, one or more of, performed during the course of an operative procedure on an artery or vein—one site (H) (Anaes.)

176.85

35202

Major arteries or veins in the neck, abdomen or extremities, access to, as part of reoperation after prior surgery on these vessels (H) (Anaes.) (Assist.)

842.60

35300

Transluminal balloon angioplasty of one peripheral artery or vein of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)

531.45

35303

Transluminal balloon angioplasty of aortic arch branches, aortic visceral branches, or more than one peripheral artery or vein of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)

681.40

35306

Transluminal stent insertion, one or more stents, including associated balloon dilatation for one peripheral artery or vein of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)

628.95

35307

Transluminal stent insertion, one or more stents (not drugeluting), with or without associated balloon dilatation, for one carotid artery, percutaneous (not direct), with or without an embolic protection device, for a patient who:

(a) meets the requirements for carotid endarterectomy; and

(b) has medical or surgical comorbidities that cause the patient to be at high risk of perioperative complications from carotid endarterectomy;

excluding associated radiological services, radiological preparation and aftercare (H) (Anaes.) (Assist.)

1,156.20

35309

Transluminal stent insertion, one or more stents, including associated balloon dilatation for visceral arteries or veins, or more than one peripheral artery or vein of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)

786.15

35312

Peripheral arterial atherectomy including associated balloon dilatation of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (H) (Anaes.) (Assist.)

891.00

35315

Peripheral laser angioplasty including associated balloon dilatation of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (H) (Anaes.) (Assist.)

891.00

35317

Peripheral arterial or venous catheterisation with administration of thrombolytic or chemotherapeutic agents, by continuous infusion, using percutaneous approach, excluding associated radiological services or preparation, and excluding aftercare (other than a service associated with a service to which an item in Subgroup 11 of Group T1 or item 35319 or 35320 applies, or associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)

366.90

35319

Peripheral arterial or venous catheterisation with administration of thrombolytic or chemotherapeutic agents, by pulse spray technique, using percutaneous approach, excluding associated radiological services or preparation, and excluding aftercare (other than a service associated with a service to which an item in Subgroup 11 of Group T1 or item 35317 or 35320 applies, or associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)

657.70

35320

Peripheral arterial or venous catheterisation with administration of thrombolytic or chemotherapeutic agents, by open exposure, excluding associated radiological services or preparation, and excluding aftercare (other than a service associated with a service to which an item in Subgroup 11 of Group T1 or item 35317 or 35319 applies, or associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)

883.45

35321

Peripheral arterial or venous catheterisation to administer agents to occlude arteries, veins or arteriovenous fistulae or to arrest haemorrhage (but not for the treatment of uterine fibroids or varicose veins), percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (other than a service associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)

838.70

35324

Angioscopy not combined with another procedure, excluding associated radiological services or preparation, and excluding aftercare (H) (Anaes.) (Assist.)

314.50

35327

Angioscopy combined with another procedure, excluding associated radiological services or preparation, and excluding aftercare (H) (Anaes.) (Assist.)

421.50

35330

Insertion of inferior vena caval filter, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)

531.45

35331

Retrieval of inferior vena caval filter, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare (H) (Anaes.)

611.00

35360

Retrieval of foreign body in pulmonary artery, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare (H) (Anaes.) (Assist.)

854.05

35361

Retrieval of foreign body in right atrium, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare (H) (Anaes.) (Assist.)

732.45

35362

Retrieval of foreign body in inferior vena cava or aorta, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare (H) (Anaes.) (Assist.)

611.00

35363

Retrieval of foreign body in peripheral vein or peripheral artery, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare (H) (Anaes.) (Assist.)

489.50

35404

Dosimetry, handling and injection of sirspheres for selective internal radiation therapy of hepatic metastases that are secondary to colorectal cancer and not suitable for resection or ablation (other than a service to which item 35317, 35319, 35320 or 35321 applies)—for any particular patient, applicable once (H) (Anaes.) (Assist.)

357.45

35406

Transfemoral catheterisation of the hepatic artery to administer sirspheres, for selective internal radiation therapy, to embolise the microvasculature of hepatic metastases, that are secondary to colorectal cancer and not suitable for resection or ablation (other than a service to which item 35317, 35319, 35320 or 35321 applies) (H) (Anaes.) (Assist.)

838.70

35408

Catheterisation of the hepatic artery via a permanently implanted hepatic artery port to administer sirspheres, for selective internal radiation therapy, to embolise the microvasculature of hepatic metastases, that are secondary to colorectal cancer and not suitable for resection or ablation (other than a service to which item 35317, 35319, 35320 or 35321 applies) (H) (Anaes.) (Assist.)

629.15

35410

Uterine artery catheterisation with percutaneous administration of occlusive agents, for the treatment of symptomatic uterine fibroids in a patient who has been referred for uterine artery embolisation by a specialist gynaecologist, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)

838.70

35412

Intracranial aneurysm, ruptured or unruptured, endovascular occlusion with detachable coils, and assisted coiling (if performed), with parent artery preservation, not for use with liquid embolics only, including intraoperative imaging, but in association with preoperative diagnostic imaging under item 60009, 60010, 60072, 60073, 60075, 60076, 60078 or 60079, including aftercare (Anaes.) (Assist.)

2,946.80

35414

Mechanical thrombectomy, in a patient with a diagnosis of acute ischaemic stroke caused by occlusion of a large vessel of the anterior cerebral circulation, including intraoperative imaging and aftercare, if:

(a) the diagnosis is confirmed by an appropriate imaging modality such as computed tomography, magnetic resonance imaging or angiography; and

(b) the service is performed by a specialist or consultant physician with appropriate training that is recognised by the Conjoint Committee for Recognition of Training in Interventional Neuroradiology; and

(c) the service is provided in an eligible stroke centre.

For any particular patient—applicable once per presentation by the patient at an eligible stroke centre, regardless of the number of times mechanical thrombectomy is attempted during that presentation (H) (Anaes.) (Assist.)

3,609.35

 

Subdivision CSubgroups 4, 5 and 6 of Group T8

5.10.17  Restriction on items in Subgroup 6 of Group T8—surgical techniques

  Items 38478 to 38766 (other than items 38609, 38615, 38618, 38621, 38624 and 38654) must be performed using open exposure or minimally invasive surgery which excludes percutaneous and transcatheter techniques unless otherwise stated in the item.

5.10.18  Items in Subgroups 4, 5 and 6 of Group T8

  This clause sets out items in Subgroups 4, 5 and 6 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 4—Gynaecological

35500

Gynaecological examination under anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)

83.85

35502

Intrauterine contraceptive device, introduction of, for the control of idiopathic menorrhagia, including endometrial biopsy to exclude endometrial pathology, other than a service associated with a service to which another item in this Group applies (Anaes.)

82.65

35503

Intrauterine contraceptive device, introduction of, if the service is not associated with a service to which another item in this Group applies (other than a service described in item 30062) (Anaes.)

55.20

35506

Intrauterine contraceptive device, removal of under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)

55.35

35507

Vulval or vaginal warts, removal of under general anaesthesia, or under regional or field nerve block (excluding pudendal block), if the time taken is less than or equal to 45 minutes—other than a service associated with a service to which item 32177 or 32180 applies (H) (Anaes.)

179.90

35508

Vulval or vaginal warts, removal of under general anaesthesia, or under regional or field nerve block (excluding pudendal block), if the time taken is greater than 45 minutes—other than a service associated with a service to which item 32177 or 32180 applies (H) (Anaes.) (Assist.)

264.95

35509

Hymenectomy (Anaes.)

92.25

35513

Bartholin’s cyst, excision of (Anaes.)

228.65

35517

Bartholin’s cyst or gland, marsupialisation of (Anaes.)

150.60

35518

Ovarian cyst aspiration, for cysts of at least 4 cm in diameter in a premenopausal person and at least 2 cm in diameter in a postmenopausal person, by abdominal or vaginal route, using interventional imaging techniques and not associated with services provided for assisted reproductive techniques (Anaes.)

214.35

35520

Bartholin’s abscess, incision of (Anaes.)

60.15

35523

Urethra or urethral caruncle, cauterisation of (Anaes.)

60.15

35527

Urethral caruncle, excision of (Anaes.)

150.60

35530

Clitoris, amputation of, if medically indicated (H) (Anaes.) (Assist.)

278.25

35533

Vulvoplasty or labioplasty, for repair of:

(a) female genital mutilation; or

(b) an anomaly associated with a major congenital anomaly of the urogynaecological tract;

other than a service associated with a service to which item 35536, 37836, 37050, 37842, 37851 or 43882 applies (H) (Anaes.)

360.80

35534

Vulvoplasty or labioplasty, in a patient aged 18 years or more, performed by a specialist in the practice of the specialist’s specialty, for a structural abnormality that is causing significant functional impairment, if the patient’s labium extends more than 8 cm below the vaginal introitus while the patient is in a standing resting position (H) (Anaes.)

360.80

35536

Vulva, wide local excision of suspected malignancy or hemivulvectomy, one or both procedures (Anaes.) (Assist.)

359.35

35539

Colposcopically directed CO2 laser therapy for previously confirmed intraepithelial neoplastic changes of the cervix, vagina, vulva, urethra or anal canal, including any associated biopsies—one anatomical site (Anaes.)

281.45

35542

Colposcopically directed CO2 laser therapy for previously confirmed intraepithelial neoplastic changes of the cervix, vagina, vulva, urethra or anal canal, including any associated biopsies—2 or more anatomical sites (Anaes.) (Assist.)

329.55

35545

Colposcopically directed CO2 laser therapy for condylomata, unsuccessfully treated by other methods (Anaes.)

189.35

35548

Vulvectomy, radical, for malignancy (H) (Anaes.) (Assist.)

860.10

35551

Pelvic lymph nodes, excision of (radical) (H) (Anaes.) (Assist.)

705.25

35554

Vagina, dilatation of, as an independent procedure including any associated consultation (Anaes.)

44.85

35557

Vagina, removal of simple tumour—(including Gartner duct cyst) (Anaes.)

221.20

35560

Vagina, partial or complete removal of (H) (Anaes.) (Assist.)

705.25

35561

Vaginectomy, radical, for proven invasive malignancy—one surgeon (H) (Anaes.) (Assist.)

1,422.55

35562

Vaginectomy, radical, for proven invasive malignancy, conjoint surgery—abdominal surgeon (including aftercare) (H) (Anaes.) (Assist.)

1,167.95

35564

Vaginectomy, radical, for proven invasive malignancy, conjoint surgery—perineal surgeon (H) (Assist.)

539.15

35565

Vaginal reconstruction for congenital absence, gynatresia or urogenital sinus (H) (Anaes.) (Assist.)

705.25

35566

Vaginal septum, excision of, for correction of double vagina (H) (Anaes.) (Assist.)

409.65

35568

Sacrospinous colpopexy for the management of upper vaginal prolapse (H) (Anaes.) (Assist.)

644.10

35569

Plastic repair to enlarge vaginal orifice (H) (Anaes.)

165.85

35572

Colpotomy, other than a service to which another item in this Group applies (H) (Anaes.)

127.70

35578

Le Fort operation for genital prolapse, other than a service associated with a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

695.60

35595

Laparoscopic or abdominal pelvic floor repair involving the fixation of the uterosacral and cardinal ligaments to rectovaginal and pubocervical fascia for symptomatic upper vaginal vault prolapse (H) (Anaes.) (Assist.)

1,191.10

35596

Fistula between genital and urinary or alimentary tracts, repair of, other than a service to which item 37029, 37333 or 37336 applies (H) (Anaes.) (Assist.)

705.25

35597

Sacral colpopexy, laparoscopic or open procedure, if graft or mesh is secured to the vault, the anterior and posterior compartments and to the sacrum for correction of symptomatic upper vaginal vault prolapse (H) (Anaes.) (Assist.)

1,519.20

35599

Stress incontinence, sling operation for, with or without mesh or tape, other than a service associated with a service to which item 30405 applies (H) (Anaes.) (Assist.)

695.60

35602

Stress incontinence, combined synchronous abdominovaginal operation for—abdominal procedure, with or without mesh, (including aftercare), other than a service associated with a service to which item 30405 applies (H) (Anaes.) (Assist.)

695.60

35605

Stress incontinence, combined synchronous abdominovaginal operation for—vaginal procedure, with or without mesh, (including aftercare), other than a service associated with a service to which item 30405 applies (Anaes.) (Assist.)

377.40

35608

Cervix, cauterisation (other than by chemical means), ionisation, diathermy or biopsy of, with or without dilatation of cervix (Anaes.)

65.95

35611

Cervix, removal of polyp or polypi, with or without dilatation of cervix, other than a service associated with a service to which item 35608 applies (Anaes.)

65.95

35612

Cervix, residual stump, removal of, by abdominal approach (Anaes.) (Assist.)

521.80

35613

Cervix, residual stump, removal of, by vaginal approach (H) (Anaes.) (Assist.)

417.45

35614

Examination of lower genital tract by a Hinselmanntype colposcope in a patient with a previous abnormal cervical smear, an abnormal result from a cervical screening service or a history of maternal ingestion of oestrogen or if a patient, because of suspicious signs of cancer, has been referred by another medical practitioner (Anaes.)

65.85

35615

Vulva, biopsy of, when performed in conjunction with a service to which item 35614 applies

55.35

35616

Endometrium, endoscopic examination of and ablation of, by microwave, thermal balloon or radiofrequency electrosurgery, for chronic refractory menorrhagia including any hysteroscopy performed on the same day, with or without uterine curettage (H) (Anaes.)

463.65

35618

Cervix, cone biopsy, amputation or repair of, other than a service to which item 35577 or 35578 applies (Anaes.)

Note: Item 35577 is specified in a determination made under subsection 3C(1) of the Act.

224.80

35620

Endometrial biopsy if malignancy is suspected in patients with abnormal uterine bleeding or postmenopausal bleeding (Anaes.)

55.00

35622

Endometrium, endoscopic ablation of, by laser or diathermy, for chronic refractory menorrhagia including any hysteroscopy performed on the same day, with or without uterine curettage, other than a service associated with a service to which item 30390 applies (H) (Anaes.)

621.30

35623

Hysteroscopic resection of myoma, or myoma and uterine septum resection (if both are performed), followed by endometrial ablation by laser or diathermy (H) (Anaes.)

844.85

35626

Hysteroscopy, including biopsy, performed by a specialist in the practice of the specialist’s specialty, if the patient is referred to the specialist for the investigation of suspected intrauterine pathology (with or without local anaesthetic), other than a service associated with a service to which item 35627 or 35630 applies

85.35

35627

Hysteroscopy with dilatation of the cervix performed in the operating theatre of a hospital—other than a service associated with a service to which item 35626 or 35630 applies (H) (Anaes.)

110.50

35630

Hysteroscopy, with endometrial biopsy, performed in the operating theatre of a hospital—other than a service associated with a service to which item 35626 or 35627 applies (H) (Anaes.)

188.75

35633

Hysteroscopy with uterine adhesiolysis or polypectomy or tubal catheterisation (including hysteroscopy for insertion of device for sterilisation) or removal of IUD which cannot be removed by other means—one or more of (Anaes.)

224.80

35634

Hysteroscopic resection of uterine septum followed by endometrial ablation by laser or diathermy (Anaes.)

707.10

35635

Hysteroscopy involving resection of the uterine septum (H) (Anaes.)

308.80

35636

Hysteroscopy, involving resection of myoma, or resection of myoma and uterine septum (if both are performed) (H) (Anaes.)

446.55

35637

Laparoscopy, involving puncture of cysts, diathermy of endometriosis, ventrosuspension, division of adhesions or similar procedure—one or more procedures with or without biopsy—other than a service associated with another laparoscopic procedure or hysterectomy (H) (Anaes.) (Assist.)

419.35

35638

Complicated operative laparoscopy, including use of laser when required, for one or more of the following procedures:

(a) oophorectomy;

(b) ovarian cystectomy;

(c) myomectomy;

(d) salpingectomy;

(e) salpingostomy;

(f) ablation of moderate or severe endometriosis requiring more than 1 hour’s operating time;

(g) division of uterosacral ligaments for significant dysmenorrhoea;

other than a service associated with another intraperitoneal or retroperitoneal procedure except item 30393 (H) (Anaes.) (Assist.)

733.75

35640

Uterus, curettage of, with or without dilatation (including curettage for incomplete miscarriage) under general anaesthesia or under epidural or spinal (intrathecal) nerve block, including procedures to which item 35626, 35627 or 35630 applies, if performed (H) (Anaes.)

188.75

35641

Endometriosis level 4 or 5, laparoscopic resection of, involving any 2 of the following procedures:

(a) resection of the pelvic side wall including dissection of endometriosis or scar tissue from the ureter;

(b) resection of the Pouch of Douglas;

(c) resection of an ovarian endometrioma greater than 2 cm in diameter;

(d) dissection of bowel from uterus from the level of the endocervical junction or above;

if the operating time exceeds 90 minutes (H) (Anaes.) (Assist.)

1,281.50

35643

Evacuation of the contents of the gravid uterus by curettage or suction curettage other than a service to which item 35640 applies, including procedures to which item 35626, 35627 or 35630 applies, if performed (Anaes.)

224.80

35644

Cervix, electrocoagulation diathermy with colposcopy, for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, other than a service associated with a service to which item 35640 or 35647 applies (Anaes.)

210.00

35645

Cervix, electrocoagulation diathermy with colposcopy, for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, in association with ablative therapy of additional areas of intraepithelial change in one or more sites of vagina, vulva, urethra or anus, other than a service associated with a service to which item 35649 applies (Anaes.)

328.65

35646

Cervix, colposcopy with radical diathermy of, with or without cervical biopsy, for previously confirmed intraepithelial neoplastic changes of the cervix (Anaes.)

210.00

35647

Cervix, large loop excision of transformation zone together with colposcopy for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, other than a service associated with a service to which item 35644 applies (Anaes.)

210.00

35648

Cervix, large loop excision diathermy for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, in conjunction with ablative treatment of additional areas of intraepithelial change of one or more sites of vagina, vulva, urethra or anus, other than a service associated with a service to which item 35645 applies (Anaes.)

328.65

35649

Hysterotomy or uterine myomectomy, abdominal (H) (Anaes.) (Assist.)

552.75

35653

Hysterectomy, abdominal, subtotal or total, with or without removal of uterine adnexae (H) (Anaes.) (Assist.)

695.80

35657

Hysterectomy, vaginal, with or without uterine curettage, other than a service to which item 35673 applies (H) (Anaes.) (Assist.)

695.80

35658

Uterus (at least equivalent in size to a 10 week gravid uterus), debulking of, before vaginal removal at hysterectomy (H) (Anaes.) (Assist.)

429.05

35661

Hysterectomy, abdominal, requiring extensive retroperitoneal dissection with or without exposure of one or both ureters, for the management of severe endometriosis, pelvic inflammatory disease or benign pelvic tumours, with or without conservation of ovaries (H) (Anaes.) (Assist.)

898.55

35664

Radical hysterectomy with radical excision of pelvic lymph nodes (with or without excision of uterine adnexae) for proven malignancy including excision of any one or more of parametrium, paracolpos, upper vagina or contiguous pelvic peritoneum and involving ureterolysis if performed (H) (Anaes.) (Assist.)

1,497.60

35667

Radical hysterectomy without gland dissection (with or without excision of uterine adnexae) for proven malignancy including excision of any one or more of parametrium, paracolpos, upper vagina or contiguous pelvic peritoneum and involving ureterolysis if performed (H) (Anaes.) (Assist.)

1,272.80

35670

Hysterectomy, abdominal, with radical excision of pelvic lymph nodes, with or without removal of uterine adnexae (H) (Anaes.) (Assist.)

1,048.05

35673

Hysterectomy, vaginal, (with or without uterine curettage) with salpingectomy, oophorectomy or excision of ovarian cyst, one or more, one or both sides (H) (Anaes.) (Assist.)

781.45

35674

Ultrasound guided needling and injection of ectopic pregnancy

214.35

35677

Ectopic pregnancy, removal of (H) (Anaes.) (Assist.)

552.75

35678

Ectopic pregnancy, laparoscopic removal of (H) (Anaes.) (Assist.)

666.45

35680

Bicornuate uterus, plastic reconstruction for (Anaes.) (Assist.)

600.20

35684

Uterus, suspension or fixation of, as an independent procedure (H) (Anaes.) (Assist.)

485.90

35688

Sterilisation by transection or resection of fallopian tubes, via abdominal or vaginal routes or via laparoscopy using diathermy or another method (H) (Anaes.) (Assist.)

409.65

35691

Sterilisation by interruption of fallopian tubes when performed in conjunction with Caesarean section (H) (Anaes.) (Assist.)

163.65

35694

Tuboplasty (salpingostomy, salpingolysis or tubal implantation into uterus), unilateral or bilateral, one or more procedures (H) (Anaes.) (Assist.)

657.60

35697

Microsurgical tuboplasty (salpingostomy, salpingolysis or tubal implantation into uterus), unilateral or bilateral, one or more procedures (H) (Anaes.) (Assist.)

975.75

35700

Fallopian tubes, unilateral microsurgical anastomosis of, using operating microscope (H) (Anaes.) (Assist.)

752.90

35703

Hydrotubation of fallopian tubes as a nonrepetitive procedure, other than a service associated with a service to which another item in this Subgroup applies (Anaes.)

69.65

35706

Rubin test for patency of fallopian tubes (Anaes.)

69.65

35709

Fallopian tubes, hydrotubation of, as a repetitive postoperative procedure (Anaes.)

44.85

35710

Falloposcopy, unilateral or bilateral, including hysteroscopy and tubal catheterisation (H) (Anaes.) (Assist.)

477.75

35713

Laparotomy, involving oophorectomy, salpingectomy, salpingooophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—one such procedure, other than a service associated with hysterectomy (H) (Anaes.) (Assist.)

467.00

35717

Laparotomy, involving oophorectomy, salpingectomy, salpingooophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—2 or more such procedures, unilateral or bilateral, other than a service associated with hysterectomy (H) (Anaes.) (Assist.)

562.30

35720

Radical or debulking operation for advanced gynaecological malignancy, with or without omentectomy (H) (Anaes.) (Assist.)

695.60

35723

Retroperitoneal lymph node biopsies from above the level of the aortic bifurcation, for staging or restaging of gynaecological malignancy (H) (Anaes.) (Assist.)

498.20

35726

Infracolic omentectomy with multiple peritoneal biopsies for staging or restaging of gynaecological malignancy (H) (Anaes.) (Assist.)

498.20

35729

Ovarian transposition out of the pelvis, in conjunction with radical hysterectomy for invasive malignancy (H) (Anaes.)

224.60

35730

Ovarian repositioning for one or both ovaries to preserve ovarian function, prior to gonadotoxic radiotherapy when the treatment volume and dose of radiation have a high probability of causing infertility (H) (Anaes.)

224.60

35750

Laparoscopically assisted hysterectomy, including any associated laparoscopy (H) (Anaes.) (Assist.)

809.10

35753

Laparoscopically assisted hysterectomy, with one or more of the following procedures—salpingectomy, oophorectomy, excision of ovarian cyst or treatment of moderate endometriosis, one or both sides, including any associated laparoscopy (H) (Anaes.) (Assist.)

894.70

35754

Laparoscopically assisted hysterectomy which requires dissection of endometriosis, or other pathology, from the ureter, one or both sides, including any associated laparoscopy, including when performed with one or more of the following procedures—salpingectomy, oophorectomy, excision of ovarian cyst or treatment of endometriosis, other than a service to which item 35641 applies (H) (Anaes.) (Assist.)

1,126.00

35756

Laparoscopically assisted hysterectomy, when procedure is completed by open hysterectomy, including any associated laparoscopy (H) (Anaes.) (Assist.)

809.10

35759

Procedure for the control of postoperative haemorrhage following gynaecological surgery, under general anaesthesia, utilising a vaginal or abdominal and vaginal approach if no other procedure is performed (H) (Anaes.) (Assist.)

580.90

Subgroup 5—Urological

36502

Pelvic lymphadenectomy, open or laparoscopic, or both, unilateral or bilateral (H) (Anaes.) (Assist.)

705.25

36503

Renal transplant, other than a service to which item 36506 or 36509 applies (H) (Anaes.) (Assist.)

1,434.60

36504

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with biopsy of bladder, not being a service associated with a service to which item 36505, 36507, 36508, 36812, 36830, 36836, 36840, 36845, 36848, 36854, 37203, 37206, 37215, 37230 or 37233 applies (Anaes.)

304.05

36505

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with urethroscopy with or without urethral dilatation, not being a service associated with any other urological endoscopic procedure on the lower urinary tract except a service to which item 37327 applies (Anaes.)

238.95

36506

Renal transplant, performed by vascular surgeon and urologist operating together—vascular anastomosis, including aftercare (H) (Anaes.) (Assist.)

953.60

36507

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with diathermy, resection or visual laser destruction of bladder tumour or other lesion of the bladder, not being a service to which item 36840 or 36845 applies (Anaes.)

400.30

36508

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with diathermy, resection or visual laser destruction of multiple tumours in more than 2 quadrants of the bladder or solitary tumour greater than 2 cm in diameter, not being a service to which item 36845 applies (Anaes.)

780.05

36509

Renal transplant, performed by vascular surgeon and urologist operating together—ureterovesical anastomosis, including aftercare (H) (Assist.)

807.45

36516

Nephrectomy, complete (H) (Anaes.) (Assist.)

953.60

36519

Nephrectomy, complete, complicated by previous surgery on the same kidney (H) (Anaes.) (Assist.)

1,331.45

36522

Nephrectomy, partial (H) (Anaes.) (Assist.)

1,142.60

36525

Nephrectomy, partial, complicated by previous surgery on the same kidney (H) (Anaes.) (Assist.)

1,623.65

36526

Nephrectomy, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour of less than 10 cm in diameter, if performed if malignancy is clinically suspected but not confirmed by histopathological examination (Anaes.) (Assist.)

1,331.45

36527

Nephrectomy, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour of 10 cm or more in diameter, or complicated by previous open or laparoscopic surgery on the same kidney, if performed if malignancy is clinically suspected but not confirmed by histopathological examination (Anaes.) (Assist.)

1,643.20

36528

Nephrectomy, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour less than 10 cm in diameter (H) (Anaes.) (Assist.)

1,331.45

36529

Nephrectomy, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour 10 cm or more in diameter, or complicated by previous open or laparoscopic surgery on the same kidney (H) (Anaes.) (Assist.)

1,643.20

36531

Nephroureterectomy, complete, including associated bladder repair and any associated endoscopic procedure (H) (Anaes.) (Assist.)

1,194.05

36532

Nephroureterectomy, for tumour, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures (H) (Anaes.) (Assist.)

1,713.80

36533

Nephroureterectomy, for tumour, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures, complicated by previous open or laparoscopic surgery on the same kidney or ureter (H) (Anaes.) (Assist.)

2,025.55

36537

Kidney or perinephric area, exploration of, with or without drainage of, by open exposure, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

713.00

36540

Nephrolithotomy or pyelolithotomy, or both, through the same skin incision, for one or 2 stones (Anaes.) (Assist.)

1,142.60

36543

Nephrolithotomy or pyelolithotomy, or both, extended, for staghorn stone or 3 or more stones, including one or more of the following:

(a) nephrostomy;

(b) pyelostomy;

(c) pedicle control with or without freezing;

(d) calyorrhaphy;

(e) pyeloplasty

(Anaes.) (Assist.)

1,331.45

36546

Extracorporeal shock wave lithotripsy (ESWL) to urinary tract and posttreatment care for 3 days, including pretreatment consultations, unilateral (Anaes.)

713.00

36549

Ureterolithotomy (H) (Anaes.) (Assist.)

859.15

36552

Nephrostomy or pyelostomy, open, as an independent procedure (H) (Anaes.) (Assist.)

764.65

36558

Renal cyst or cysts, excision or unroofing of (Anaes.) (Assist.)

670.10

36561

Renal biopsy (closed) (Anaes.)

177.90

36564

Pyeloplasty (plastic reconstruction of the pelviureteric junction), by open exposure, laparoscopy or laparoscopic assisted techniques (H) (Anaes.) (Assist.)

953.60

36567

Pyeloplasty in a kidney that is congenitally abnormal in addition to the presence of pelvicureteric junction obstruction, or in a solitary kidney, by open exposure (H) (Anaes.) (Assist.)

1,048.05

36570

Pyeloplasty, complicated by previous surgery on the same kidney, by open exposure (H) (Anaes.) (Assist.)

1,331.45

36573

Divided ureter, repair of (H) (Anaes.) (Assist.)

953.60

36576

Kidney, exposure and exploration of, including repair or nephrectomy, for trauma, via open laparoscopic or robotassisted approach, other than a service associated with:

(a) any other procedure performed on the kidney, renal pelvis or renal pedicle; or

(b) a service to which item 30390 or 30627 applies

(Anaes.) (Assist.)

1,194.05

36579

Ureterectomy, complete or partial, with or without associated bladder repair, other than a service associated with a service to which item 37000 applies (H) (Anaes.) (Assist.)

764.65

36585

Ureter, transplantation of, into skin (H) (Anaes.) (Assist.)

764.65

36588

Ureter, reimplantation into bladder (H) (Anaes.) (Assist.)

953.60

36591

Ureter, reimplantation into bladder with psoas hitch or Boari flap or both (H) (Anaes.) (Assist.)

1,142.60

36594

Ureter, transplantation of, into intestine (H) (Anaes.) (Assist.)

953.60

36597

Ureter, transplantation of, into another ureter (H) (Anaes.) (Assist.)

953.60

36600

Ureter, transplantation of, into isolated intestinal segment, unilateral (Anaes.) (Assist.)

1,142.60

36603

Ureters, transplantation of, into isolated intestinal segment, bilateral (H) (Anaes.) (Assist.)

1,331.45

36604

Ureteric stent, passage of through percutaneous nephrostomy tube, using interventional imaging techniques (Anaes.)

276.05

36605

Ureteric stent, insertion of, with removal of calculus from:

(a) the pelvicalyceal system; or

(b) ureter; or

(c) the pelvicalyceal system and ureter;

through a nephrostomy tube using interventional imaging techniques (H) (Anaes.)

712.30

36606

Intestinal urinary reservoir, continent, formation of, including formation of nonreturn valves and implantation of ureters (one or both) into reservoir (H) (Anaes.) (Assist.)

2,388.15

36607

Ureteric stent, insertion of, with balloon dilatation of:

(a) the pelvicalyceal system; or

(b) ureter; or

(c) the pelvicalyceal system and ureter;

through a nephrostomy tube using interventional imaging techniques (H) (Anaes.)

712.30

36608

Ureteric stent, exchange of, percutaneously through the ileal conduit or bladder using interventional imaging techniques, other than a service associated with a service to which any of items 36811 to 36854 apply (H) (Anaes.)

276.05

36609

Intestinal urinary conduit or ureterostomy, revision of (H) (Anaes.) (Assist.)

764.65

36612

Ureter, exploration of, with or without drainage of, as an independent procedure (H) (Anaes.) (Assist.)

670.10

36615

Ureterolysis, with or without repositioning of ureter, for obstruction of the ureter, evident either radiologically or by proximal ureteric dilatation at operation, secondary to retroperitoneal fibrosis, or similar condition (H) (Anaes.) (Assist.)

764.65

36618

Reduction ureteroplasty (H) (Anaes.) (Assist.)

670.10

36621

Closure of cutaneous ureterostomy (H) (Anaes.) (Assist.)

479.05

36624

Nephrostomy, percutaneous, using interventional imaging techniques (Anaes.) (Assist.)

575.55

36627

Nephroscopy, percutaneous, with or without any one or more of stone extraction, biopsy or diathermy, other than a service to which item 36639, 36642, 36645 or 36648 applies (H) (Anaes.)

713.00

36630

Nephroscopy, being a service to which item 36627 applies, if, after a substantial portion of the procedure has been performed, it is necessary to discontinue the operation due to bleeding (H) (Anaes.) (Assist.)

352.15

36633

Nephroscopy, percutaneous, with incision of any one or more of renal pelvis, calyx or calyces or ureter and including antegrade insertion of ureteric stent, other than a service associated with a service to which item 36627, 36639, 36642, 36645 or 36648 applies (Anaes.) (Assist.)

764.65

36636

Nephroscopy, percutaneous, with incision of any one or more of renal pelvis, calyx or calyces or ureter and including antegrade insertion of ureteric stent, being a service associated with a service to which item 36627, 36639, 36642, 36645 or 36648 applies (H) (Anaes.) (Assist.)

412.40

36639

Nephroscopy, percutaneous, with destruction and extraction of one or 2 stones using ultrasound or electrohydraulic shock waves or lasers (other than a service to which item 36645 or 36648 applies) (H) (Anaes.)

859.15

36642

Nephroscopy, being a service to which item 36639 applies, if, after a substantial portion of the procedure has been performed, it is necessary to discontinue the operation due to bleeding (H) (Anaes.) (Assist.)

429.45

36645

Nephroscopy, percutaneous, with removal or destruction of a stone greater than 3 cm in any dimension, or for 3 or more stones (H) (Anaes.) (Assist.)

1,099.60

36648

Nephroscopy, being a service to which item 36645 applies, if, after a substantial portion of the procedure has been performed, it is necessary to discontinue the operation (H) (Anaes.) (Assist.)

979.25

36649

Nephrostomy drainage tube, exchange of—but not including imaging (Anaes.) (Assist.)

276.05

36650

Nephrostomy tube, removal of, using interventional imaging techniques, if the ureter has been stented with a double J ureteric stent and that stent is left in place (H) (Anaes.)

154.40

36652

Pyeloscopy, retrograde, of one collecting system, with or without any one or more of, cystoscopy, ureteric meatotomy, ureteric dilatation, other than a service associated with a service to which item 36803, 36812 or 36824 applies (H) (Anaes.) (Assist.)

670.10

36654

Pyeloscopy, retrograde, of one collecting system, being a service to which item 36652 applies, plus one or more of extraction of stone from the renal pelvis or calyces, or biopsy or diathermy of the renal pelvis or calyces, other than a service associated with a service performed in the same collecting system to which item 36656 applies (H) (Anaes.) (Assist.)

859.15

36656

Pyeloscopy, retrograde, of one collecting system, being a service to which item 36652 applies, plus extraction of 2 or more stones in the renal pelvis or calyces or destruction of stone with ultrasound, electrohydraulic or kinetic lithotripsy or laser in the renal pelvis or calyces, with or without extraction of fragments, other than a service associated with a service performed in the same collecting system to which item 36654 applies (H) (Anaes.) (Assist.)

1,099.60

36663

Both:

(a) percutaneous placement of sacral nerve lead or leads using fluoroscopic guidance, or open placement of sacral nerve lead or leads; and

(b) intraoperative test stimulation, to manage:

(i) detrusor overactivity that has been refractory to at least 12 months conservative nonsurgical treatment; or

(ii) nonobstructive urinary retention that has been refractory to at least 12 months conservative nonsurgical treatment

(Anaes.)

681.60

36664

Both:

(a) percutaneous repositioning of sacral nerve lead or leads using fluoroscopic guidance, or open repositioning of sacral nerve lead or leads; and

(b) intraoperative test stimulation, to correct displacement or unsatisfactory positioning, if inserted for the management of:

(i) detrusor overactivity that has been refractory to at least 12 months conservative nonsurgical treatment; or

(ii) nonobstructive urinary retention that has been refractory to at least 12 months conservative nonsurgical treatment;

other than a service to which item 36663 applies (Anaes.)

612.10

36665

Sacral nerve electrode or electrodes, management and adjustment of the pulse generator by a medical practitioner, to manage detrusor overactivity or nonobstructive urinary retention—each day

129.30

36666

Pulse generator, subcutaneous placement of, and placement and connection of extension wire or wires to sacral nerve electrode or electrodes, for the management of:

(a) detrusor overactivity that has been refractory to at least 12 months conservative nonsurgical treatment; or

(b) nonobstructive urinary retention that has been refractory to at least 12 months conservative nonsurgical treatment

(Anaes.)

344.45

36667

Sacral nerve lead or leads, removal of, if the lead was inserted to manage:

(a) detrusor overactivity that has been refractory to at least 12 months conservative nonsurgical treatment; or

(b) nonobstructive urinary retention that has been refractory to at least 12 months conservative nonsurgical treatment

(Anaes.)

161.20

36668

Pulse generator, removal of, if the pulse generator was inserted to manage:

(a) detrusor overactivity that has been refractory to at least 12 months conservative nonsurgical treatment; or

(b) nonobstructive urinary retention that has been refractory to at least 12 months conservative nonsurgical treatment

(Anaes.)

161.20

36671

Percutaneous tibial nerve stimulation, initial treatment protocol, for the treatment of overactive bladder, by a specialist urologist, gynaecologist or urogynaecologist, if:

(a) the patient has been diagnosed with idiopathic overactive bladder; and

(b) the patient has been refractory to, is contraindicated or otherwise not suitable for, conservative treatments (including anticholinergic agents); and

(c) the patient is contraindicated or otherwise not a suitable candidate for botulinum toxin type A therapy; and

(d) the patient is contraindicated or otherwise not a suitable candidate for sacral nerve stimulation; and

(e) the patient is willing and able to comply with the treatment protocol; and

(f) the initial treatment protocol comprises 12 sessions, delivered over a 3 month period; and

(g) each session lasts for a minimum of 45 minutes, of which neurostimulation lasts for 30 minutes

Applicable only once, unless the patient achieves at least a 50% reduction in overactive bladder symptoms from baseline at any time during the 3 month treatment period

Not applicable to a service associated with a service to which item 36672 or 36673 applies

206.25

36672

Percutaneous tibial nerve stimulation, tapering treatment protocol, for the treatment of overactive bladder, including any associated consultation at the time the percutaneous tibial nerve stimulation treatment is administered, if:

(a) the patient responded to the percutaneous tibial nerve stimulation initial treatment protocol and has achieved at least a 50% reduction in overactive bladder symptoms from baseline at any time during the treatment period for the initial treatment protocol; and

(b) the tapering treatment protocol comprises no more than 5 sessions, delivered over a 3 month period, and the interval between sessions is adjusted with the aim of sustaining therapeutic benefit of the treatment; and

(c) each session lasts for a minimum of 45 minutes, of which neurostimulation lasts for 30 minutes.

Not applicable to a service associated with a service to which item 36671 or 36673 applies

206.25

36673

Percutaneous tibial nerve stimulation, maintenance treatment protocol, for the treatment of overactive bladder, including any associated consultation at the time the percutaneous tibial nerve stimulation treatment is administered, if:

(a) the patient responded to the percutaneous tibial nerve stimulation initial treatment protocol and to the tapering treatment protocol, and has achieved at least a 50% reduction in overactive bladder symptoms from baseline at any time during the treatment period for the initial treatment protocol; and

(b) the maintenance treatment protocol comprises no more than 12 sessions, delivered over a 12 month period, and the interval between sessions is adjusted with the aim of sustaining therapeutic benefit of the treatment; and

(c) each session lasts for a minimum of 45 minutes, of which neurostimulation lasts for 30 minutes

Not applicable to service associated with a service to which item 36671 or 36672 applies

206.25

36800

Bladder, catheterisation of, if no other procedure is performed (Anaes.)

28.45

36803

Ureteroscopy, of one ureter, with or without any one or more of cystoscopy, ureteric meatotomy, or ureteric dilatation, other than a service associated with a service to which item 36652, 36654, 36656, 36806, 36809, 36812, 36824, 36848 or 36857 applies (Anaes.) (Assist.)

480.90

36806

Ureteroscopy, of one ureter, with or without any one or more of, cystoscopy, ureteric meatotomy or ureteric dilatation, plus one or more of extraction of stone from the ureter, or biopsy or diathermy of the ureter, other than a service associated with a service to which item 36803 or 36812 applies, or a service associated with a service to which item 36809, 36824, 36848 or 36857 applies to a procedure performed on the same ureter (H) (Anaes.) (Assist.)

670.10

36809

Ureteroscopy, of one ureter, with or without any one or more of, cystoscopy, ureteric meatotomy or ureteric dilatation, plus destruction of stone in the ureter with ultrasound, electrohydraulic or kinetic lithotripsy or laser, with or without extraction of fragments, other than a service

associated with a service to which item 36803 or 36812 applies, or a service associated with a service to which item 36806, 36824, 36848 or 36857 applies to a procedure performed on the same ureter (H) (Anaes.) (Assist.)

859.15

36811

Cystoscopy with insertion of urethral prosthesis (Anaes.)

333.50

36812

Cystoscopy with urethroscopy, with or without urethral dilatation, other than a service associated with another urological endoscopic procedure on the lower urinary tract except a service to which item 37327 applies (Anaes.)

171.90

36815

Cystoscopy, with or without urethroscopy, for the treatment of penile warts or urethral warts, other than a service associated with a service to which item 30189 applies (Anaes.)

245.35

36818

Cystoscopy, with ureteric catheterisation including fluoroscopic imaging of the upper urinary tract, unilateral or bilateral, other than a service associated with a service to which item 36824 or 36830 applies (Anaes.) (Assist.)

285.25

36821

Cystoscopy with one or more of ureteric dilatation, insertion of ureteric stent, or brush biopsy of ureter or of renal pelvis, unilateral, other than a service associated with a service to which item 36824 or 36830 applies (Anaes.) (Assist.)

333.30

36824

Cystoscopy with ureteric catheterisation, unilateral or bilateral, other than a service associated with a service to which item 36818 or 36821 applies (Anaes.)

219.80

36825

Cystoscopy, with endoscopic incision of pelviureteric junction or ureteric stricture, including removal or replacement of ureteric stent, other than a service associated with a service to which item 36818, 36821, 36824, 36830 or 36833 applies (H) (Anaes.) (Assist.)

599.45

36827

Cystoscopy, with controlled hydrodilatation of the bladder (Anaes.)

237.05

36830

Cystoscopy, with ureteric meatotomy (H) (Anaes.)

209.60

36833

Cystoscopy with removal of ureteric stent or other foreign body (Anaes.) (Assist.)

285.25

36836

Cystoscopy with biopsy of bladder, other than a service associated with a service to which item 36812, 36830, 36840, 36845, 36848, 36854, 37203, 37206, 37215, 37230 or 37233 applies (Anaes.)

237.05

36840

Cystoscopy, with resection, diathermy or visual laser destruction of bladder tumour or other lesion of the bladder, other than a service associated with a service to which item 36845 applies (Anaes.)

333.30

36842

Cystoscopy with lavage of blood clots from bladder including any associated diathermy of prostate or bladder, other than a service associated with a service to which item 36812, 36827 to 36863, 37203, 37206, 37230 or 37233 applies (H) (Anaes.) (Assist.)

335.35

36845

Cystoscopy, with diathermy, resection or visual laser destruction of multiple tumours in more than 2 quadrants of the bladder or solitary tumour greater than 2 cm in diameter (Anaes.)

713.00

36848

Cystoscopy with resection of ureterocele (H) (Anaes.)

237.05

36851

Cystoscopy with injection into bladder wall, other than a service associated with a service to which item 18375 or 18379 applies (H) (Anaes.)

237.05

36854

Cystoscopy with endoscopic incision or resection of external sphincter, bladder neck or both (H) (Anaes.)

480.90

36857

Endoscopic manipulation or extraction of ureteric calculus (H) (Anaes.)

377.90

36860

Endoscopic examination of intestinal conduit or reservoir (Anaes.)

171.90

36863

Litholapaxy, with or without cystoscopy (H) (Anaes.) (Assist.)

480.90

37000

Bladder, partial excision of (H) (Anaes.) (Assist.)

764.65

37004

Bladder, repair of rupture (H) (Anaes.) (Assist.)

670.10

37008

Cystostomy or cystotomy, suprapubic, other than a service to which item 37011 applies or a service associated with other open bladder procedure (Anaes.)

429.45

37011

Suprapubic stab cystotomy, other than a service associated with a service to which items 37200 to 37221 or 37226 apply (Anaes.)

96.25

37014

Bladder, total excision of (H) (Anaes.) (Assist.)

1,099.60

37020

Bladder diverticulum, excision or obliteration of (H) (Anaes.) (Assist.)

764.65

37023

Vesical fistula, cutaneous, operation for (H) (Anaes.)

429.45

37026

Cutaneous vesicostomy, establishment of (H) (Anaes.) (Assist.)

429.45

37029

Vesicovaginal fistula, closure of, by abdominal approach (H) (Anaes.) (Assist.)

953.60

37038

Vesicointestinal fistula, closure of, excluding bowel resection (H) (Anaes.) (Assist.)

713.35

37040

Bladder stress incontinence, sling procedure for, using a nonadjustable synthetic male sling system, with or without mesh, other than a service associated with a service to which item 30405, 35599 or 37042 applies (H) (Anaes.) (Assist.)

939.80

37041

Bladder aspiration, by needle

48.05

37042

Bladder stress incontinence—sling procedure for, using autologous fascial sling, including harvesting of sling, with or without mesh, other than a service associated with a service to which item 30405 or 35599 applies (H) (Anaes.) (Assist.)

939.80

37043

Bladder stress incontinence, Stamey or similar type needle colposuspension, with or without mesh, other than a service associated with a service to which item 30405 or 35599 applies (H) (Anaes.) (Assist.)

695.60

37044

Bladder stress incontinence, suprapubic procedure for, e.g., Burch colposuspension, with or without mesh, other than a service associated with a service to which item 30405 or 35599 applies (H) (Anaes.) (Assist.)

713.35

37045

Continent catheterisation bladder stomas (for example, Mitrofanoff), formation of (H) (Anaes.) (Assist.)

1,473.35

37047

Bladder enlargement using intestine (H) (Anaes.) (Assist.)

1,718.10

37050

Bladder exstrophy closure, not involving sphincter reconstruction (H) (Anaes.) (Assist.)

764.65

37053

Bladder transection and reanastomosis to trigone (H) (Anaes.) (Assist.)

883.45

37200

Prostatectomy, open (H) (Anaes.) (Assist.)

1,048.05

37201

Prostate, transurethral radiofrequency needle ablation of, with or without cystoscopy and with or without urethroscopy, in patients with moderate to severe lower urinary tract symptoms who are not medically fit for transurethral resection of the prostate (that is, prostatectomy using diathermy or cold punch) and including a service to which item 36854, 37203, 37206, 37207, 37208, 37245, 37303, 37321 or 37324 applies (H) (Anaes.)

854.75

37202

Prostate, transurethral radiofrequency needle ablation of, with or without cystoscopy and with or without urethroscopy, in patients with moderate to severe lower urinary tract symptoms who are not medically fit for transurethral resection of the prostate (that is prostatectomy using diathermy or cold punch) and including a service to which item 36854, 37245, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203 or 37207 which had to be discontinued for medical reasons (Anaes.)

429.05

37203

Prostatectomy (endoscopic, using diathermy or cold punch), with or without cystoscopy, and with or without urethroscopy, and including services to which item 36854, 37201, 37202, 37207, 37208, 37245, 37303, 37321 or 37324 applies (H) (Anaes.)

1,074.70

37206

Prostatectomy (endoscopic, using diathermy or cold punch), with or without cystoscopy, and with or without urethroscopy, and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203, 37207 or 37245 which had to be discontinued for medical reasons (H) (Anaes.)

575.55

37207

Prostate, endoscopic noncontact (side firing) visual laser ablation, with or without cystoscopy, and with or without urethroscopy, and including services to which item 36854, 37201, 37202, 37203, 37206, 37245, 37303, 37321 or 37324 applies (H) (Anaes.)

1,074.70

37208

Prostate, endoscopic noncontact (side firing) visual laser ablation, with or without cystoscopy, and with or without urethroscopy, and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203, 37207 or 37245 which had to be discontinued for medical reasons (H) (Anaes.)

575.55

37209

Total excision (other than a service associated with a service to which item 37210 or 37211 applies) of any, or all of:

(a) prostate; or

(b) seminal vesicle, unilateral or bilateral; or

(c) ampulla of vas, unilateral or bilateral

(H) (Anaes.) (Assist.)

1,331.45

37210

Prostatectomy, radical, involving total excision of the prostate, sparing of nerves around the bladder and bladder neck reconstruction, other than a service associated with a service to which item 35551, 36502 or 37375 applies (H) (Anaes.) (Assist.)

1,643.20

37211

Prostatectomy, radical, involving total excision of the prostate, sparing of nerves around the bladder and bladder neck reconstruction, with pelvic lymphadenectomy, other than a service associated with a service to which item 35551, 36502 or 37375 applies (H) (Anaes.) (Assist.)

1,995.65

37212

Prostate, open perineal biopsy or open drainage of abscess (H) (Anaes.) (Assist.)

285.25

37215

Prostate, biopsy of, endoscopic, with or without cystoscopy (Anaes.) (Assist.)

429.45

37217

Prostate, implantation of radioopaque fiducial markers into the prostate gland or prostate surgical bed (Anaes.)

142.60

37218

Prostate, needle biopsy of, or injection into, excluding insertion of radioopaque markers (Anaes.)

142.60

37219

Prostate, needle biopsy of, using prostatic ultrasound techniques and obtaining one or more prostatic specimens, being a service associated with a service to which item 55600 or 55603 applies (Anaes.) (Assist.)

289.65

37220

Prostate, radioactive seed implantation of, urological component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stage T1 (clinically inapparent tumour that is not palpable or visible by imaging) or clinical stage T2 (tumour confined within prostate), with a Gleason score of not more than 7 and a prostate specific antigen (PSA) of 10ng/ml or less at the time of diagnosis, if the procedure is performed by a urologist at an approved site in association with a radiation oncologist, and being a service associated with a service to which item 55603 applies (H) (Anaes.)

1,076.80

37221

Prostatic abscess, endoscopic drainage of (H) (Anaes.) (Assist.)

480.90

37223

Prostatic coil, insertion of, under ultrasound control (H) (Anaes.)

212.70

37224

Prostate, diathermy or visual laser destruction of lesion of, other than a service associated with a service to which item 37201, 37202, 37203, 37206, 37207, 37208, 37215, 37230 or 37233 applies (Anaes.)

333.30

37226

Prostate or prostatic bed, needle biopsy of, using prostatic magnetic resonance imaging techniques and obtaining one or more prostatic specimens (Anaes.)

289.65

37227

Prostate, transperineal insertion of catheters for high dose rate brachytherapy using ultrasound guidance including any associated cystoscopy, if performed at an approved site, and being a service associated with a service to which item 15331 or 15332 applies

583.50

37230

Prostate, highenergy transurethral microwave thermotherapy of, with or without cystoscopy, and with or without urethroscopy, and including services to which item 36854, 37203, 37206, 37207, 37208, 37303, 37321 or 37324 applies (Anaes.)

1,074.70

37233

Prostate, highenergy transurethral microwave thermotherapy of, with or without cystoscopy, and with or without urethroscopy, and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203, 37207 or 37230 which had to be discontinued for medical reasons (Anaes.)

575.55

37245

Prostate, endoscopic enucleation of, using high powered Holmium:YAG laser and an end firing, noncontact fibre, with or without tissue morcellation, cystoscopy or urethroscopy, for the treatment of benign prostatic hyperplasia and other than a service associated with a service to which item 36854, 37201, 37202, 37203, 37206, 37207, 37208, 37303, 37321 or 37324 applies (H) (Anaes.)

1,301.60

37300

Urethral sounds, passage of, as an independent procedure (Anaes.)

48.05

37303

Urethral stricture, dilatation of (Anaes.)

76.40

37306

Urethra, repair of rupture of distal section (H) (Anaes.) (Assist.)

670.10

37309

Urethra, repair of rupture of prostatic or membranous segment (H) (Anaes.) (Assist.)

953.60

37315

Urethroscopy, as an independent procedure (Anaes.)

142.60

37318

Urethroscopy, with any one or more of biopsy, diathermy, visual laser destruction of stone or removal of foreign body or stone (Anaes.) (Assist.)

285.25

37321

Urethral meatotomy, external (Anaes.)

96.25

37324

Urethrotomy or urethrostomy, internal or external (H) (Anaes.)

237.05

37327

Urethrotomy, optical, for urethral stricture (H) (Anaes.) (Assist.)

333.30

37330

Urethrectomy, partial or complete, for removal of tumour (H) (Anaes.) (Assist.)

670.10

37333

Urethrovaginal fistula, closure of (H) (Anaes.) (Assist.)

575.55

37336

Urethrorectal fistula, closure of (H) (Anaes.) (Assist.)

764.65

37338

Urethral synthetic male sling system, division or removal of, for urethral obstruction or erosion, following previous surgery for urinary incontinence, other than a service associated with a service to which item 37340 or 37341 applies (H) (Anaes.) (Assist.)

939.80

37339

Periurethral or transurethral injection of materials for the treatment of urinary incontinence, including cystoscopy and urethroscopy, other than a service associated with a service to which item 18375 or 18379 applies (Anaes.)

247.35

37340

Urethral sling, division or removal of, for urethral obstruction or erosion, following previous surgery for urinary incontinence—vaginal approach, other than a service associated with a service to which item 37341 applies (H) (Anaes.) (Assist.)

438.30

37341

Urethral sling, division or removal of, for urethral obstruction or erosion, following previous surgery for urinary incontinence—suprapubic or vaginal approach, other than a service associated with a service to which item 37340 applies (H) (Anaes.) (Assist.)

939.80

37342

Urethroplasty—single stage operation (H) (Anaes.) (Assist.)

859.15

37343

Urethroplasty, single stage operation, transpubic approach via separate incisions above and below the symphysis pubis, excluding laparotomy, symphysectomy and suprapubic cystotomy, with or without rerouting of the urethra around the crura (H) (Anaes.) (Assist.)

1,434.60

37345

Urethroplasty—2 stage operation—first stage (H) (Anaes.) (Assist.)

713.00

37348

Urethroplasty—2 stage operation—second stage (H) (Anaes.) (Assist.)

713.00

37351

Urethroplasty, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

285.25

37354

Hypospadias, meatotomy and hemicircumcision (H) (Anaes.) (Assist.)

333.30

37369

Urethra, excision of prolapse of (H) (Anaes.)

192.45

37372

Urethral diverticulum, excision of (H) (Anaes.) (Assist.)

480.90

37375

Urethral sphincter, reconstruction by bladder tubularisation technique or similar procedure (H) (Anaes.) (Assist.)

1,194.05

37381

Artificial urinary sphincter, insertion of cuff, perineal approach (H) (Anaes.) (Assist.)

764.65

37384

Artificial urinary sphincter, insertion of cuff, abdominal approach (H) (Anaes.) (Assist.)

1,194.05

37387

Artificial urinary sphincter, insertion of pressure regulating balloon and pump (H) (Anaes.) (Assist.)

333.30

37390

Artificial urinary sphincter, revision or removal of, with or without replacement (H) (Anaes.) (Assist.)

953.60

37393

Priapism, decompression by glanular stab cavernosospongiosum shunt or penile aspiration with or without lavage (Anaes.)

237.05

37396

Priapism, shunt operation for, other than a service to which item 37393 applies (H) (Anaes.) (Assist.)

764.65

37402

Penis, partial amputation of (H) (Anaes.) (Assist.)

480.90

37405

Penis, complete or radical amputation of (H) (Anaes.) (Assist.)

953.60

37408

Penis, repair of laceration of cavernous tissue, or fracture involving cavernous tissue (H) (Anaes.) (Assist.)

480.90

37411

Penis, repair of avulsion (Anaes.) (Assist.)

953.60

37415

Penis, injection of, for the investigation and treatment of impotence—2 services only in a period of 36 consecutive months

48.05

37417

Penis, correction of chordee, with or without excision of fibrous plaque or plaques and with or without grafting (H) (Anaes.) (Assist.)

575.55

37418

Penis, correction of chordee, with or without excision of fibrous plaque or plaques and with or without grafting, involving mobilisation of the urethra (Anaes.) (Assist.)

764.65

37420

Penis, surgery to inhibit rapid penile drainage causing impotence, by ligation of veins deep to Buck’s fascia including one or more deep cavernosal veins, with or without pharmacological erection test (H) (Anaes.) (Assist.)

377.90

37423

Penis, lengthening by translocation of corpora (H) (Anaes.) (Assist.)

953.60

37426

Penis, artificial erection device, insertion of, into one or both corpora (H) (Anaes.) (Assist.)

1,005.00

37429

Penis, artificial erection device, insertion of pump and pressure regulating reservoir (H) (Anaes.) (Assist.)

333.30

37432

Penis, artificial erection device, complete or partial revision or removal of components, with or without replacement (H) (Anaes.) (Assist.)

953.60

37435

Penis, frenuloplasty as an independent procedure (Anaes.)

96.25

37438

Scrotum, partial excision of (Anaes.) (Assist.)

285.25

37444

Ureterolithotomy complicated by previous surgery at the same site of the same ureter (Anaes.) (Assist.)

1,030.90

37601

Spermatocele or epididymal cyst, excision of, one or more of, on one side (Anaes.)

285.25

37604

Exploration of scrotal contents, with or without fixation and with or without biopsy, unilateral, other than a service associated with sperm harvesting for IVF (Anaes.)

285.25

37605

Transcutaneous sperm retrieval, unilateral, from either the testis or the epididymis, for the purposes of intracytoplasmic sperm injection, for male factor infertility, other than a service to which item 13218 applies (Anaes.)

385.15

37606

Open surgical sperm retrieval, unilateral, including the exploration of scrotal contents, with or without biopsy, for the purposes of intracytoplasmic sperm injection, for male factor infertility, performed in a hospital, other than a service to which item 13218 or 37604 applies (Anaes.)

571.85

37607

Retroperitoneal lymph node dissection, unilateral, other than a service associated with a service to which item 36528 applies (H) (Anaes.) (Assist.)

953.60

37610

Retroperitoneal lymph node dissection, unilateral, other than a service associated with a service to which item 36528 applies, following previous similar retroperitoneal dissection, retroperitoneal irradiation or chemotherapy (H) (Anaes.) (Assist.)

1,434.60

37613

Epididymectomy (Anaes.)

285.25

37616

Vasovasostomy or vasoepididymostomy, unilateral, using the operating microscope, other than a service associated with sperm harvesting for IVF (H) (Anaes.) (Assist.)

713.00

37619

Vasovasostomy or vasoepididymostomy, unilateral, other than a service associated with sperm harvesting for IVF (Anaes.) (Assist.)

285.25

37623

Vasotomy or vasectomy, unilateral or bilateral (Anaes.)

237.05

37800

Patent urachus, excision of, on a person 10 years of age or over (H) (Anaes.) (Assist.)

537.55

37801

Patent urachus, excision of, on a person under 10 years of age (H) (Anaes.) (Assist.)

698.85

37803

Undescended testis, orchidopexy for, on a person 10 years of age or over, other than a service to which item 37806 applies (H) (Anaes.) (Assist.)

537.55

37804

Undescended testis, orchidopexy for, on a person under 10 years of age, other than a service to which item 37807 applies (H) (Anaes.) (Assist.)

698.85

37806

Undescended testis in inguinal canal close to deep inguinal ring or within abdominal cavity, orchidopexy for, on a person 10 years of age or over (Anaes.) (Assist.)

621.10

37807

Undescended testis in inguinal canal close to deep inguinal ring or within abdominal cavity, orchidopexy for, on a person under 10 years of age (Anaes.) (Assist.)

807.45

37809

Undescended testis, revision orchidopexy for, on a person 10 years of age or over (H) (Anaes.) (Assist.)

621.10

37810

Undescended testis, revision orchidopexy for, on a person under 10 years of age (H) (Anaes.) (Assist.)

807.45

37812

Impalpable testis, exploration of groin for, on a person 10 years of age or over, other than a service associated with a service to which any of items 37803, 37806 and 37809 apply (H) (Anaes.) (Assist.)

573.35

37813

Impalpable testis, exploration of groin for, on a person under 10 years of age, other than a service associated with a service to which any of items 37804, 37807 and 37810 apply (H) (Anaes.) (Assist.)

745.35

37815

Hypospadias, examination under anaesthesia with erection test, on a person 10 years of age or over (H) (Anaes.)

95.65

37816

Hypospadias, examination under anaesthesia with erection test, on a person under 10 years of age (H) (Anaes.)

124.40

37818

Hypospadias, glanuloplasty incorporating meatal advancement, on a person 10 years of age or over (Anaes.) (Assist.)

506.80

37819

Hypospadias, glanuloplasty incorporating meatal advancement, on a person under 10 years of age (Anaes.) (Assist.)

658.85

37821

Hypospadias, distal, one stage repair, on a person 10 years of age or over (H) (Anaes.) (Assist.)

859.15

37822

Hypospadias, distal, one stage repair, on a person under 10 years of age (H) (Anaes.) (Assist.)

1,116.90

37824

Hypospadias, proximal, one stage repair, on a person 10 years of age or over (H) (Anaes.) (Assist.)

1,194.50

37825

Hypospadias, proximal, one stage repair, on a person under 10 years of age (H) (Anaes.) (Assist.)

1,552.85

37827

Hypospadias, staged repair, first stage, on a person 10 years of age or over (H) (Anaes.) (Assist.)

550.30

37828

Hypospadias, staged repair, first stage, on a person under 10 years of age (H) (Anaes.) (Assist.)

715.35

37830

Hypospadias, staged repair, second stage, on a person 10 years of age or over (Anaes.) (Assist.)

713.00

37831

Hypospadias, staged repair, second stage, on a person under 10 years of age (Anaes.) (Assist.)

927.00

37833

Hypospadias, repair of postoperative urethral fistula, on a person 10 years of age or over (H) (Anaes.) (Assist.)

340.30

37834

Hypospadias, repair of postoperative urethral fistula, on a person under 10 years of age (H) (Anaes.) (Assist.)

442.35

37836

Epispadias, staged repair, first stage (H) (Anaes.) (Assist.)

716.70

37839

Epispadias, staged repair, second stage (H) (Anaes.) (Assist.)

812.20

37842

Exstrophy of bladder or epispadias, secondary repair with bladder neck tightening, with or without ureteric reimplantation (H) (Anaes.) (Assist.)

1,576.85

37845

Ambiguous genitalia with urogenital sinus, reduction clitoroplasty, with or without endoscopy (H) (Anaes.) (Assist.)

716.70

37848

Ambiguous genitalia with urogenital sinus, reduction clitoroplasty, with endoscopy and vaginoplasty (H) (Anaes.) (Assist.)

1,290.10

37851

Congenital adrenal hyperplasia, mixed gonadal dysgenesis or similar condition, vaginoplasty for, with or without endoscopy (H) (Anaes.) (Assist.)

955.75

37854

Urethral valve, destruction of, including cystoscopy and urethroscopy (H) (Anaes.) (Assist.)

377.90

Subgroup 6—Cardiothoracic

38200

Right heart catheterisation with any one or more of the following:

(a) fluoroscopy;

(b) oximetry;

(c) dye dilution curves;

(d) cardiac output measurement by any method;

(e) shunt detection;

(f) exercise stress test

(Anaes.)

459.35

38203

Left heart catheterisation by percutaneous arterial puncture, arteriotomy or percutaneous left ventricular puncture with any one or more of the following:

(a) fluoroscopy;

(b) oximetry;

(c) dye dilution curves;

(d) cardiac output measurements by any method;

(e) shunt detection;

(f) exercise stress test

(Anaes.)

548.15

38206

Right heart catheterisation with left heart catheterisation via the right heart or by another procedure, with any one or more of the following:

(a) fluoroscopy;

(b) oximetry;

(c) dye dilution curves;

(d) cardiac output measurements by any method;

(e) shunt detection;

(f) exercise stress test

(Anaes.)

662.75

38209

Cardiac electrophysiological study—up to and including 3 catheter investigation of any one or more of—syncope, atrioventricular conduction, sinus node function or simple ventricular tachycardia studies, other than a service associated with a service to which item 38212 or 38213 applies (Anaes.)

850.95

38212

Cardiac electrophysiological study:

(a) 4 or more catheter supraventricular tachycardia investigation; or

(b) complex tachycardia inductions; or

(c) multiple catheter mapping; or

(d) acute intravenous antiarrhythmic drug testing with pre and post drug inductions; or

(e) catheter ablation to intentionally induce complete AV block; or

(f) intraoperative mapping; or

(g) electrophysiological services during defibrillator implantation or testing;

other than a service associated with a service to which item 38209 or 38213 applies (Anaes.)

1,415.30

38213

Cardiac electrophysiological study, for followup testing of implanted defibrillator—other than a service associated with a service to which item 38209 or 38212 applies (Anaes.)

421.50

38215

Selective coronary angiography—placement of catheters and injection of opaque material into the native coronary arteries, other than a service associated with a service to which item 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)

366.00

38218

Selective coronary angiography—placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography, other than a service associated with a service to which item 38215, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)

548.85

38220

Selective coronary graft angiography—placement of one or more catheters and injection of opaque material into free coronary graft attached to the aorta (any number of grafts), other than a service associated with a service to which item 38215, 38218, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)

182.95

38222

Selective coronary graft angiography—placement of one or more catheters and injection of opaque material into direct internal mammary artery graft to one or more coronary arteries (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)

366.00

38225

Selective coronary angiography—placement of catheters and injection of opaque material into the native coronary arteries and placement of one or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)

548.95

38228

Selective coronary angiography—placement of catheters and injection of opaque material into the native coronary arteries and placement of one or more catheters and injection of opaque material into direct internal mammary artery graft to one or more coronary arteries (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)

732.05

38231

Selective coronary angiography—placement of catheters and injection of opaque material into the native coronary arteries and placement of one or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), and placement of one or more catheters and injection of opaque material into direct internal mammary artery graft to one or more coronary arteries (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38234, 38237, 38240 or 38246 applies (Anaes.)

914.95

38234

Selective coronary angiography—placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of one or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38237, 38240 or 38246 applies (Anaes.)

731.90

38237

Selective coronary angiography—placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of one or more catheters and injection of opaque material into direct internal mammary artery graft to one or more coronary arteries (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38240 or 38246 applies (Anaes.)

914.90

38240

Selective coronary angiography—placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of one or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), and placement of one or more catheters and injection of opaque material into direct internal mammary artery graft to one or more coronary arteries (irrespective of the number of grafts), other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237 or 38246 applies (Anaes.)

1,097.85

38241

Use of a coronary pressure wire during selective coronary angiography to measure fractional flow reserve (FFR) and coronary flow reserve (CFR) in one or more intermediate coronary artery or graft lesions (stenosis of 30—70%), to determine whether revascularisation should be performed, if previous stress testing has either not been performed or the results are inconclusive (Anaes.)

484.35

38243

Placement of one or more catheters and injection of opaque material into any one or more coronary vessels or grafts before any coronary interventional procedure, other than a service associated with a service to which item 38246 applies (Anaes.)

457.45

38246

Selective coronary angiography—placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography followed by placement of catheters before any coronary interventional procedure, other than a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38243 applies (Anaes.)

914.90

38256

Temporary transvenous pacemaking electrode, insertion of (Anaes.)

275.60

38270

Balloon valvuloplasty or isolated atrial septostomy, including cardiac catheterisations before and after balloon dilatation (Anaes.) (Assist.)

940.80

38272

Atrial septal defect, closure using a septal occluder or similar device by transcatheter approach (Anaes.) (Assist.)

940.80

38273

Patent ductus arteriosus, transcatheter closure of, including cardiac catheterisation and any imaging associated with the service (H) (Anaes.) (Assist.)

940.80

38274

Ventricular septal defect, transcatheter closure of, with imaging and cardiac catheterisation (H) (Anaes.) (Assist.)

940.80

38275

Myocardial biopsy, by cardiac catheterisation (Anaes.)

307.50

38276

Transcatheter occlusion of left atrial appendage, and cardiac catheterisation performed by the same practitioner, for stroke prevention in a patient who has nonvalvular atrial fibrillation and a contraindication to lifelong oral anticoagulation therapy, and is at increased risk of thromboembolism demonstrated by:

(a) a prior stroke (whether of an ischaemic or unknown type), transient ischaemic attack or noncentral nervous system systemic embolism; or

(b) at least 2 of the following risk factors:

(i) an age of 65 years or more;

(ii) hypertension;

(iii) diabetes mellitus;

(iv) heart failure or left ventricular ejection fraction of 35% or less (or both);

(v) vascular disease (prior myocardial infarction, peripheral artery disease or aortic plaque)

(H) (Anaes.) (Assist.)

940.80

38285

Implantable ECG loop recorder, insertion of, for diagnosis of primary disorder, if:

(a) the patient to whom the service is provided:

(i) has recurrent unexplained syncope; and

(ii) does not have a structural heart defect associated with a high risk of sudden cardiac death; and

(b) a diagnosis has not been achieved through all other available cardiac investigations; and

(c) a neurogenic cause is not suspected;

including initial programming and testing (H) (Anaes.)

198.95

38286

Implantable ECG loop recorder, removal of (H) (Anaes.)

179.20

38287

Ablation of arrhythmia circuit or focus or isolation procedure involving one atrial chamber (Anaes.) (Assist.)

2,164.05

38288

Implantable loop recorder, insertion of, for diagnosis of atrial fibrillation, if:

(a) the patient to whom the service is provided has been diagnosed as having had an embolic stroke of undetermined source; and

(b) the bases of the diagnosis included the following:

(i) the medical history of the patient;

(ii) physical examination;

(iii) brain and carotid imaging;

(iv) cardiac imaging;

(v) surface ECG testing including 24hour Holter monitoring; and

(c) atrial fibrillation is suspected; and

(d) the patient:

(i) does not have a permanent indication for oral anticoagulants; or

(ii) does not have a permanent oral anticoagulants contraindication;

including initial programming and testing (Anaes.)

198.95

38290

Ablation of arrhythmia circuits or foci, or isolation procedure involving both atrial chambers and including curative procedures for atrial fibrillation (H) (Anaes.) (Assist.)

2,755.40

38293

Ventricular arrhythmia with mapping and ablation, including all associated electrophysiological studies performed on the same day (Anaes.) (Assist.)

2,957.65

38300

Transluminal balloon angioplasty of one coronary artery, percutaneous or by open exposure, excluding associated radiological services, radiological preparation and aftercare (Anaes.) (Assist.)

531.45

38303

Transluminal balloon angioplasty of more than one coronary artery, percutaneous or by open exposure, excluding associated radiological services, radiological preparation and aftercare (Anaes.) (Assist.)

681.40

38306

Transluminal insertion of stent or stents into one occlusional site, including associated balloon dilatation of coronary artery, percutaneous or by open exposure, excluding associated radiological services, radiological preparation and aftercare (Anaes.) (Assist.)

786.15

38309

Percutaneous transluminal rotational atherectomy of one coronary artery, including balloon angioplasty without stent insertion, if:

(a) no lesion of the coronary artery has been stented; and

(b) each lesion of the coronary artery is complex and heavily calcified; and

(c) balloon angioplasty, with or without stenting, is not suitable;

excluding associated radiological services, radiological preparation and aftercare (Anaes.) (Assist.)

913.10

38312

Percutaneous transluminal rotational atherectomy of one coronary artery, including balloon angioplasty with the insertion of one or more stents, if:

(a) no lesion of the coronary artery has been stented; and

(b) each lesion of the coronary artery is complex and heavily calcified; and

(c) balloon angioplasty, with or without stenting, is not suitable;

excluding associated radiological services, radiological preparation and aftercare (H) (Anaes.) (Assist.)

1,167.70

38315

Percutaneous transluminal rotational atherectomy of more than one coronary artery, including balloon angioplasty without stent insertion, if:

(a) no lesion of the coronary artery has been stented; and

(b) each lesion of the coronary arteries is complex and heavily calcified; and

(c) balloon angioplasty, with or without stenting, is not suitable;

excluding associated radiological services, radiological preparation and aftercare (H) (Anaes.) (Assist.)

1,253.85

38318

Percutaneous transluminal rotational atherectomy of more than one coronary artery, including balloon angioplasty, with the insertion of one or more stents, if:

(a) no lesion of the coronary artery has been stented; and

(b) each lesion of the coronary arteries is complex and heavily calcified; and

(c) balloon angioplasty with or without stenting is not suitable;

excluding associated radiological services, radiological preparation and aftercare (H) (Anaes.) (Assist.)

1,635.95

38350

Single chamber permanent transvenous electrode (including cardiac electrophysiological services if used for pacemaker implantation), insertion, removal or replacement of (Anaes.)

658.60

38353

Permanent cardiac pacemaker (including cardiac electrophysiological services if used for pacemaker implantation), insertion, removal or replacement of—other than a service for the purpose of cardiac resynchronisation therapy (H) (Anaes.)

263.45

38356

Dual chamber permanent transvenous electrodes (including cardiac electrophysiological services if used for pacemaker implantation), insertion, removal or replacement of (H) (Anaes.)

863.50

38358

Extraction, by percutaneous method, of a chronically implanted transvenous pacing or defibrillator lead, if the lead has been in place for more than 6 months, and requires removal:

(a) with locking stylets, snares or extraction sheaths; and

(b) in a facility where cardiac surgery is available;

being a service associated with item 61109 or 60509 (H) (Anaes.) (Assist.)

2,957.65

38359

Pericardium, paracentesis of (excluding aftercare) (Anaes.)

137.75

38362

Intraaortic balloon pump, percutaneous insertion of (H) (Anaes.)

396.95

38365

Permanent cardiac synchronisation device (including a cardiac synchronisation device that is capable of defibrillation), insertion, removal or replacement of, for a patient who:

(a) has:

(i) moderate to severe chronic heart failure (New York Heart Association (NYHA) class III or IV) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 120 ms; or

(b) satisfied the requirements mentioned in paragraph (a) immediately before the insertion of a cardiac resynchronisation therapy device and transvenous left ventricle electrode

(H) (Anaes.)

263.45

38368

Permanent transvenous left ventricular electrode, insertion, removal or replacement of through the coronary sinus, for the purpose of cardiac resynchronisation therapy, including right heart catheterisation and any associated venogram of left ventricular veins, other than a service associated with a service to which item 35200 or 38200 applies, for a patient who:

(a) has:

(i) moderate to severe chronic heart failure (New York Heart Association (NYHA) class III or IV) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 120 ms; or

(b) has:

(i) mild chronic heart failure (New York Heart Association (NYHA) class II) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 150 ms; or

(c) satisfied the requirements mentioned in paragraph (a) or (b) immediately before the insertion of a cardiac resynchronisation therapy device and transvenous left ventricle electrode

(H) (Anaes.)

1,262.85

38371

Permanent cardiac synchronisation device capable of defibrillation, insertion, removal or replacement of, for a patient who:

(a) has:

(i) moderate to severe chronic heart failure (NYHA class III or IV) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 120 ms; or

(b) has:

(i) mild chronic heart failure (New York Heart Association (NYHA) class II) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 150 ms

(H) (Anaes.)

296.85

38384

Automatic defibrillator, insertion of patches for, or insertion of transvenous endocardial defibrillation electrodes for, primary prevention of sudden cardiac death in:

(a) a patient with a left ventricular ejection fraction of less than or equal to 30% at least one month after a myocardial infarct despite optimised medical therapy; or

(b) a patient with chronic heart failure associated with mild to moderate symptoms (NYHA II and III) and a left ventricular ejection fraction less than or equal to 35% despite optimised medical therapy;

other than a service associated with a service to which item 38213 applies (H) (Anaes.) (Assist.)

1,085.55

38387

Automatic defibrillation generator (other than a defibrillator capable of cardiac resynchronisation therapy), insertion or replacement of, for primary prevention of sudden cardiac death in:

(a) a patient with a left ventricular ejection fraction of less than or equal to 30% at least one month after a myocardial infarct despite optimised medical therapy; or

(b) a patient with chronic heart failure associated with mild to moderate symptoms (NYHA II and III) and a left ventricular ejection fraction less than or equal to 35% despite optimised medical therapy;

other than a service associated with a service to which item 38213 applies (H) (Anaes.) (Assist.)

296.85

38390

Automatic defibrillator, insertion of patches or transvenous endocardial defibrillation electrodes for, other than for primary prevention for tachycardia arrhythmias or a service associated with a service to which item 38213 applies (H) (Anaes.) (Assist.)

1,085.55

38393

Automatic defibrillator generator (other than a defibrillator capable of cardiac resynchronisation therapy), insertion or replacement of, other than for primary prevention for tachycardia arrhythmias or a service associated with a service to which item 38213 applies (H) (Anaes.) (Assist.)

296.85

38415

Empyema, radical operation for, involving resection of rib (Anaes.) (Assist.)

411.85

38418

Thoracotomy, exploratory, with or without biopsy (H) (Anaes.) (Assist.)

988.35

38421

Thoracotomy, with pulmonary decortication (H) (Anaes.) (Assist.)

1,579.85

38424

Thoracotomy, with pleurectomy or pleurodesis, or enucleation of hydatid cysts (H) (Anaes.) (Assist.)

988.35

38427

Thoracoplasty (complete)—3 or more ribs (H) (Anaes.) (Assist.)

1,220.40

38430

Thoracoplasty (in stages)—each stage (H) (Anaes.) (Assist.)

628.95

38436

Thoracoscopy, with or without division of pleural adhesions, including insertion of intercostal catheter, if necessary, with or without biopsy (H) (Anaes.)

257.55

38438

Pneumonectomy or lobectomy or segmentectomy other than a service associated with a service to which item 38418 applies (H) (Anaes.) (Assist.)

1,579.85

38440

Lung, wedge resection of (H) (Anaes.) (Assist.)

1,183.05

38441

Radical lobectomy or pneumonectomy including resection of chest wall, diaphragm, pericardium, or formal mediastinal node dissection (H) (Anaes.) (Assist.)

1,871.90

38446

Thoracotomy or sternotomy, for removal of thymus or mediastinal tumour (H) (Anaes.) (Assist.)

1,220.40

38447

Pericardiectomy via sternotomy or anterolateral thoracotomy without cardiopulmonary bypass (H) (Anaes.) (Assist.)

1,579.85

38448

Mediastinum, cervical exploration of, with or without biopsy (H) (Anaes.) (Assist.)

374.40

38449

Pericardiectomy via sternotomy or anterolateral thoracotomy with cardiopulmonary bypass (H) (Anaes.) (Assist.)

2,210.15

38450

Pericardium, transthoracic open surgical drainage of (H) (Anaes.) (Assist.)

883.40

38452

Pericardium, subxiphoid open surgical drainage of (H) (Anaes.) (Assist.)

591.65

38453

Tracheal excision and repair without cardiopulmonary bypass (H) (Anaes.) (Assist.)

1,774.70

38455

Tracheal excision and repair of, with cardiopulmonary bypass (H) (Anaes.) (Assist.)

2,400.40

38456

Intrathoracic operation on heart, lungs, great vessels, bronchial tree, oesophagus or mediastinum, or on more than one of those organs, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

1,579.85

38457

Pectus excavatum or pectus carinatum, repair or radical correction of (H) (Anaes.) (Assist.)

1,474.95

38458

Pectus excavatum, repair of, with implantation of subcutaneous prosthesis (H) (Anaes.) (Assist.)

786.15

38460

Sternal wires or wires, removal of (H) (Anaes.)

284.00

38462

Sternotomy wound, debridement of, not involving reopening of the mediastinum (H) (Anaes.)

336.60

38464

Sternotomy wound, debridement of, involving curettage of infected bone with or without removal of wires but not involving reopening of the mediastinum (H) (Anaes.)

365.90

38466

Sternum, reoperation on, for dehiscence or infection involving reopening of the mediastinum, with or without rewiring (H) (Anaes.) (Assist.)

987.95

38468

Sternum and mediastinum, reoperation for infection of, involving muscle advancement flaps or greater omentum (H) (Anaes.) (Assist.)

1,522.25

38469

Sternum and mediastinum, reoperation for infection of, involving muscle advancement flaps and greater omentum (H) (Anaes.) (Assist.)

1,774.70

38470

Permanent myocardial electrode, insertion of, by thoracotomy or sternotomy (H) (Anaes.) (Assist.)

988.35

38473

Permanent pacemaker electrode, insertion by open surgical approach (H) (Anaes.) (Assist.)

591.65

38475

Valve annuloplasty without insertion of ring, other than a service associated with a service to which item 38480 or 38481 applies (H) (Anaes.) (Assist.)

857.75

38477

Valve annuloplasty with insertion of ring other than a service to which item 38478 applies (H) (Anaes.) (Assist.)

2,065.95

38478

Valve annuloplasty with insertion of ring performed in conjunction with item 38480 or 38481 (H) (Anaes.) (Assist.)

1,000.75

38480

Valve repair, one leaflet (H) (Anaes.) (Assist.)

2,065.95

38481

Valve repair, 2 or more leaflets (H) (Anaes.) (Assist.)

2,351.90

38483

Aortic valve leaflet or leaflets, decalcification of, other than a service to which item 38475, 38477, 38480, 38481, 38488 or 38489 applies (H) (Anaes.) (Assist.)

1,774.70

38485

Mitral annulus, reconstruction of, after decalcification, when performed in association with valve surgery (H) (Anaes.) (Assist.)

842.60

38487

Mitral valve, open valvotomy of (H) (Anaes.) (Assist.)

1,774.70

38488

Valve replacement with bioprosthesis or mechanical prosthesis (H) (Anaes.) (Assist.)

1,969.25

38489

Valve replacement with allograft (subcoronary or cylindrical implant), or unstented xenograft (H) (Anaes.) (Assist.)

2,342.00

38490

Subvalvular structures, reconstruction and reimplantation of, associated with mitral and tricuspid valve replacement (H) (Anaes.) (Assist.)

571.85

38493

Operative management of acute infective endocarditis, in association with heart valve surgery (H) (Anaes.) (Assist.)

2,018.75

38496

Artery harvesting (other than internal mammary), for coronary artery bypass (H) (Anaes.) (Assist.)

643.45

38497

Coronary artery bypass with cardiopulmonary bypass, using saphenous vein graft or grafts only, including harvesting of vein graft material if performed, other than a service associated with a service to which item 38498, 38500, 38501, 38503 or 38504 applies (H) (Anaes.) (Assist.)

2,111.55

38498

Coronary artery bypass with the aid of tissue stabilisers, performed without cardiopulmonary bypass, using saphenous vein graft or grafts only, including harvesting of vein graft material if performed, either by a median sternotomy or other minimally invasive technique, and if a standby perfusionist is present, other than a service associated with a service to which item 38497, 38500, 38501, 38503, 38504 or 38600 applies (H) (Anaes.) (Assist.)

2,111.55

38500

Coronary artery bypass with cardiopulmonary bypass, using single arterial graft, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material if performed, other than a service associated with a service to which item 38497, 38498, 38501, 38503 or 38504 applies (H) (Anaes.) (Assist.)

2,268.75

38501

Coronary artery bypass with the aid of tissue stabilisers, performed without cardiopulmonary bypass, using single arterial graft, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material if performed, either by a median sternotomy or other minimally invasive technique, and if a standby perfusionist is present, other than a service associated with a service to which item 38497, 38498, 38500, 38503, 38504 or 38600 applies (H) (Anaes.) (Assist.)

2,268.75

38503

Coronary artery bypass with cardiopulmonary bypass, using 2 or more arterial grafts, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material if performed, other than a service associated with a service to which item 38497, 38498, 38500, 38501 or 38504 applies (H) (Anaes.) (Assist.)

2,463.30

38504

Coronary artery bypass with the aid of tissue stabilisers, performed without cardiopulmonary bypass, using 2 or more arterial grafts, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material if performed, either by a median sternotomy or other minimally invasive technique, and if a standby perfusionist is present, other than a service associated with a service to which item 38497, 38498, 38500, 38501, 38503 or 38600 applies (H) (Anaes.) (Assist.)

2,463.30

38505

Coronary endarterectomy, by open operation, including repair with one or more patch grafts, each vessel (H) (Anaes.) (Assist.)

285.95

38506

Left ventricular aneurysm, plication of (H) (Anaes.) (Assist.)

1,677.05

38507

Left ventricular aneurysm resection with primary repair (H) (Anaes.) (Assist.)

1,968.85

38508

Left ventricular aneurysm resection with patch reconstruction of the left ventricle (H) (Anaes.) (Assist.)

2,463.30

38509

Ischaemic ventricular septal rupture, repair of (H) (Anaes.) (Assist.)

2,463.30

38512

Division of accessory pathway, isolation procedure, procedure on atrioventricular node or perinodal tissues involving one atrial chamber only (H) (Anaes.) (Assist.)

2,164.05

38515

Division of accessory pathway, isolation procedure, procedure on atrioventricular node or perinodal tissues involving both atrial chambers and including curative surgery for atrial fibrillation (H) (Anaes.) (Assist.)

2,755.40

38518

Ventricular arrhythmia with mapping and muscle ablation, with or without aneurysmeotomy (H) (Anaes.) (Assist.)

2,957.65

38550

Ascending thoracic aorta, repair or replacement of, not involving valve replacement or repair or coronary artery implantation (H) (Anaes.) (Assist.)

2,213.20

38553

Ascending thoracic aorta, repair or replacement of, with aortic valve replacement or repair, without implantation of coronary arteries (H) (Anaes.) (Assist.)

2,804.70

38556

Ascending thoracic aorta, repair or replacement of, with aortic valve replacement or repair, and implantation of coronary arteries (H) (Anaes.) (Assist.)

3,201.70

38559

Aortic arch and ascending thoracic aorta, repair or replacement of, not involving valve replacement or repair or coronary artery implantation (H) (Anaes.) (Assist.)

2,610.05

38562

Aortic arch and ascending thoracic aorta, repair or replacement of, with aortic valve replacement or repair, without implantation of coronary arteries (H) (Anaes.) (Assist.)

3,201.70

38565

Aortic arch and ascending thoracic aorta, repair or replacement of, with aortic valve replacement or repair, and implantation of coronary arteries (H) (Anaes.) (Assist.)

3,591.00

38568

Descending thoracic aorta, repair or replacement of, without shunt or cardiopulmonary bypass, by open exposure, percutaneous or endovascular means (H) (Anaes.) (Assist.)

1,921.15

38571

Descending thoracic aorta, repair or replacement of, using shunt or cardiopulmonary bypass (H) (Anaes.) (Assist.)

2,115.85

38572

Operative management of acute rupture or dissection, in conjunction with procedures on the thoracic aorta (H) (Anaes.) (Assist.)

2,049.15

38577

Cannulation for, and supervision and monitoring of, the administration of retrograde cerebral perfusion during deep hypothermic arrest (H) (Assist.)

571.85

38588

Cannulation of the coronary sinus for, and supervision of, the retrograde administration of blood or crystalloid for cardioplegia, including pressure monitoring (H) (Assist.)

429.05

38600

Central cannulation for cardiopulmonary bypass excluding postoperative management, other than a service associated with a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

1,579.85

38603

Peripheral cannulation for cardiopulmonary bypass excluding postoperative management (H) (Anaes.) (Assist.)

988.35

38609

Intraaortic balloon pump, insertion of, by arteriotomy (H) (Anaes.) (Assist.)

494.10

38612

Intraaortic balloon pump, removal of, with closure of artery by direct suture (Anaes.) (Assist.)

553.90

38613

Intraaortic balloon pump, removal of, with closure of artery by patch graft (H) (Anaes.) (Assist.)

695.10

38615

Insertion of a left or right ventricular assist device, for use as:

(a) a bridge to cardiac transplantation in patients with refractory heart failure who are:

(i) currently on a heart transplant waiting list; or

(ii) expected to be suitable candidates for cardiac transplantation following a period of support on the ventricular assist device; or

(b) acute post cardiotomy support for failure to wean from cardiopulmonary transplantation; or

(c) cardiorespiratory support for acute cardiac failure which is likely to recover with short term support of less than 6 weeks;

not being a service associated with the use of a ventricular assist device as destination therapy in the management of patients with heart failure who are not expected to be suitable candidates for cardiac transplantation

(H) (Anaes.) (Assist.)

1,579.85

38618

Insertion of a left and right ventricular assist device, for use as:

(a) a bridge to cardiac transplantation in patients with refractory heart failure who are:

(i) currently on a heart transplant waiting list; or

(ii) expected to be suitable candidates for cardiac transplantation following a period of support on the ventricular assist device; or

(b) acute post cardiotomy support for failure to wean from cardiopulmonary transplantation; or

(c) cardiorespiratory support for acute cardiac failure which is likely to recover with short term support of less than 6 weeks;

not being a service associated with the use of a ventricular assist device as destination therapy in the management of patients with heart failure who are not expected to be suitable candidates for cardiac transplantation

(H) (Anaes.) (Assist.)

1,969.25

38621

Left or right ventricular assist device, removal of, as an independent procedure (H) (Anaes.) (Assist.)

786.15

38624

Left and right ventricular assist device, removal of, as an independent procedure (H) (Anaes.) (Assist.)

883.40

38627

Extracorporeal membrane oxygenation, bypass or ventricular assist device cannulae, adjustment and repositioning of, by open operation, in patients supported by these devices (H) (Anaes.) (Assist.)

690.50

38637

Patent diseased coronary artery bypass vein graft or grafts, dissection, disconnection and oversewing of (H) (Anaes.) (Assist.)

571.85

38640

Reoperation via median sternotomy, for any procedure, including any divisions of adhesions if the time taken to divide the adhesions is 45 minutes or less (H) (Anaes.) (Assist.)

988.35

38643

Thoracotomy or sternotomy involving division of adhesions if the time taken to divide the adhesions exceeds 45 minutes (H) (Anaes.) (Assist.)

1,100.75

38647

Thoracotomy or sternotomy involving division of extensive adhesions if the time taken to divide the adhesions exceeds 2 hours (H) (Anaes.) (Assist.)

2,201.20

38650

Myomectomy or myotomy for hypertrophic obstructive cardiomyopathy (H) (Anaes.) (Assist.)

1,969.25

38653

Open heart surgery, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

1,969.25

38654

Permanent left ventricular electrode, insertion, removal or replacement of via open thoracotomy, for the purpose of cardiac resynchronisation therapy, for a patient who:

(a) has:

(i) moderate to severe chronic heart failure (New York Heart Association (NYHA) class III or IV) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 120 ms; or

(b) has:

(i) mild chronic heart failure (New York Heart Association (NYHA) class II) despite optimised medical therapy; and

(ii) sinus rhythm; and

(iii) a left ventricular ejection fraction of less than or equal to 35%; and

(iv) a QRS duration greater than or equal to 150 ms; or

(c) satisfied the requirements mentioned in paragraph (a) or (b) immediately before the insertion of a cardiac resynchronisation therapy device and transvenous left ventricle electrode

(H) (Anaes.) (Assist.)

1,262.85

38656

Thoracotomy or median sternotomy for postoperative bleeding (H) (Anaes.) (Assist.)

988.35

38670

Cardiac tumour, excision of, involving the wall of the atrium or interatrial septum, without patch or conduit reconstruction (H) (Anaes.) (Assist.)

1,968.85

38673

Cardiac tumour, excision of, involving the wall of the atrium or interatrial septum, requiring reconstruction with patch or conduit (H) (Anaes.) (Assist.)

2,216.00

38677

Cardiac tumour arising from ventricular myocardium, partial thickness excision of (H) (Anaes.) (Assist.)

2,073.15

38680

Cardiac tumour arising from ventricular myocardium, full thickness excision of including repair or reconstruction (Anaes.) (Assist.)

2,459.05

38700

Patent ductus arteriosus, shunt, collateral or other single large vessel, division or ligation of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,100.75

38703

Patent ductus arteriosus, shunt, collateral or other single large vessel, division or ligation of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,984.20

38706

Aorta, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,879.30

38709

Aorta, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38712

Aortic interruption, repair of, for congenital heart disease (H) (Anaes.) (Assist.)

2,643.20

38715

Main pulmonary artery, banding, debanding or repair of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,759.60

38718

Main pulmonary artery, banding, debanding or repair of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38721

Vena cava, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,542.55

38724

Vena cava, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38727

Intrathoracic vessels, anastomosis or repair of, without cardiopulmonary bypass, other than a service to which item 38700, 38703, 38706, 38709, 38712, 38715, 38718, 38721 or 38724 applies, for congenital heart disease (H) (Anaes.) (Assist.)

1,542.55

38730

Intrathoracic vessels, anastomosis or repair of, with cardiopulmonary bypass, other than a service to which item 38700, 38703, 38706, 38709, 38712, 38715, 38718, 38721 or 38724 applies, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38733

Systemic pulmonary or cavopulmonary shunt, creation of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,542.55

38736

Systemic pulmonary or cavopulmonary shunt, creation of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38739

Atrial septectomy, with or without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)

1,984.20

38742

Atrial septal defect, closure by open exposure and direct suture or patch, for congenital heart disease (H) (Anaes.) (Assist.)

1,984.20

38745

Intraatrial baffle, insertion of, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38748

Ventricular septectomy, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38751

Ventricular septal defect, closure by direct suture or patch (H) (Anaes.) (Assist.)

2,201.20

38754

Intraventricular baffle or conduit, insertion of, for congenital heart disease (H) (Anaes.) (Assist.)

2,755.40

38757

Extracardiac conduit, insertion of, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38760

Extracardiac conduit, replacement of, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38763

Ventricular myectomy, for relief of ventricular obstruction, right or left, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38766

Ventricular augmentation, right or left, for congenital heart disease (H) (Anaes.) (Assist.)

2,201.20

38800

Thoracic cavity, aspiration of, for diagnostic purposes, other than a service associated with a service to which item 38803 applies

39.70

38803

Thoracic cavity, aspiration of, with therapeutic drainage (paracentesis), with or without diagnostic sample

79.30

38806

Intercostal drain, insertion of, not involving resection of rib (excluding aftercare) (Anaes.)

137.75

38809

Intercostal drain, insertion of, with pleurodesis and not involving resection of rib (excluding aftercare) (Anaes.)

169.70

38812

Percutaneous needle biopsy of lung (Anaes.)

215.70

Subdivision DSubgroups 7 to 11 of Group T8

5.10.19  Items in Subgroups 7 to 11 of Group T8

  This clause sets out items in Subgroups 7 to 11 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 7—Neurosurgical

39000

Lumbar puncture (Anaes.)

77.65

39003

Cisternal puncture (Anaes.)

88.30

39006

Ventricular puncture (not including burrhole) (Anaes.)

164.40

39009

Subdural haemorrhage, tap for, each tap (H) (Anaes.)

61.20

39012

Burrhole, single, preparatory to ventricular puncture or for inspection purpose—other than a service to which another item applies (H) (Anaes.)

245.00

39013

Injection under image intensification with one or more of contrast media, local anaesthetic or corticosteroid into one or more zygoapophyseal or costotransverse joints or one or more primary posterior rami of spinal nerves (Anaes.)

112.55

39015

Ventricular reservoir, external ventricular drain or intracranial pressure monitoring device, insertion of—including burrhole (excluding aftercare) (H) (Anaes.) (Assist.)

387.75

39018

Cerebrospinal fluid reservoir, insertion of (H) (Anaes.) (Assist.)

387.75

39100

Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes.)

245.00

39106

Neurectomy, intracranial, for trigeminal neuralgia (H) (Anaes.) (Assist.)

1,225.30

39109

Trigeminal gangliotomy by radiofrequency, balloon or glycerol (Anaes.)

457.55

39112

Cranial nerve, intracranial decompression of, using microsurgical techniques (H) (Anaes.) (Assist.)

1,589.65

39115

Percutaneous neurotomy of posterior divisions (or rami) of spinal nerves by any method, including any associated spinal, epidural or regional nerve block (applicable once in a 30 day period) (Anaes.)

77.65

39118

Percutaneous neurotomy for facet joint denervation by radiofrequency probe or cryoprobe using radiological imaging control (Anaes.) (Assist.)

307.15

39121

Percutaneous cordotomy (Anaes.) (Assist.)

651.50

39124

Cordotomy or myelotomy, partial or total laminectomy for, or operation for dorsal root entry zone (Drez) lesion (H) (Anaes.) (Assist.)

1,667.30

39125

Intrathecal or epidural spinal catheter, insertion or replacement of, and connection to a subcutaneous implanted infusion pump, for the management of chronic intractable pain (H) (Anaes.) (Assist.)

307.35

39126

All of the following:

(a) infusion pump, subcutaneous implantation or replacement of;

(b) connection of the pump to an intrathecal or epidural spinal catheter;

(c) filling of reservoir with a therapeutic agent or agents;

with or without programming the pump, for the management of chronic intractable pain (H) (Anaes.) (Assist.)

373.20

39127

Subcutaneous reservoir and spinal catheter, insertion of, for the management of chronic intractable pain (H) (Anaes.)

488.45

39128

All of the following:

(a) infusion pump, subcutaneous implantation of;

(b) intrathecal or epidural spinal catheter, insertion of;

(c) connection of pump to catheter;

(d) filling of reservoir with a therapeutic agent or agents;

with or without programming the pump, for the management of chronic intractable pain (H) (Anaes.) (Assist.)

680.55

39130

Epidural lead, percutaneous placement of, including intraoperative test stimulation, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris—to a maximum of 4 leads (H) (Anaes.)

695.20

39131

Epidural or peripheral nerve electrodes, management, adjustment, and electronic programming of, by a medical practitioner, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris—each day

131.80

39133

Either:

(a) subcutaneously implanted infusion pump, removal of; or

(b) intrathecal or epidural spinal catheter, removal or repositioning of;

for the management of chronic intractable pain (H) (Anaes.)

164.40

39134

Neurostimulator or receiver, subcutaneous placement of, including placement and connection of extension wires to epidural or peripheral nerve electrodes, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris (H) (Anaes.) (Assist.)

351.25

39135

Neurostimulator or receiver that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, removal of, performed in the operating theatre of a hospital (H) (Anaes.)

164.40

39136

Epidural or peripheral nerve lead that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, removal of, performed in the operating theatre of a hospital (Anaes.)

164.40

39137

Epidural or peripheral nerve lead that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, surgical repositioning of, to correct displacement or unsatisfactory positioning, including intraoperative test stimulation, other than a service to which item 39130, 39138 or 39139 applies (Anaes.)

624.30

39138

Peripheral nerve lead, surgical placement of, including intraoperative test stimulation, for chronic intractable neuropathic pain or pain from refractory angina pectoris—not exceeding 4 leads (Anaes.) (Assist.)

695.20

39139

Epidural lead, surgical placement of one or more of by partial or total laminectomy, including intraoperative test stimulation, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris—to a maximum of 4 leads (H) (Anaes.) (Assist.)

933.40

39140

Epidural catheter, insertion of, under imaging control, with epidurogram and epidural therapeutic injection for lysis of adhesions (Anaes.)

302.00

39300

Cutaneous nerve (including digital nerve), primary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)

364.40

39303

Cutaneous nerve (including digital nerve), secondary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)

480.65

39306

Nerve trunk, primary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)

697.95

39309

Nerve trunk, secondary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)

736.70

39312

Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (H) (Anaes.) (Assist.)

411.00

39315

Nerve trunk, nerve graft to, (cable graft) including harvesting of nerve graft using microsurgical techniques (H) (Anaes.) (Assist.)

1,062.40

39318

Cutaneous nerve (including digital nerve), nerve graft to, using microsurgical techniques (H) (Anaes.) (Assist.)

659.20

39321

Nerve, transposition of (H) (Anaes.) (Assist.)

488.45

39323

Percutaneous neurotomy by cryotherapy or radiofrequency lesion generator, other than a service to which another item applies (Anaes.) (Assist.)

285.45

39324

Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve, by open operation (Anaes.) (Assist.)

285.45

39327

Neurectomy, neurotomy or removal of tumour from deep peripheral or cranial nerve, by open operation, other than a service to which item 41575, 41576, 41578 or 41579 applies (H) (Anaes.) (Assist.)

488.55

39330

Neurolysis by open operation without transposition, other than a service associated with a service to which item 39312 applies (H) (Anaes.) (Assist.)

285.45

39331

Carpal tunnel release (division of transverse carpal ligament), by any method (Anaes.)

285.45

39333

Brachial plexus, exploration of, other than a service to which another item in this Group applies (Anaes.) (Assist.)

411.00

39500

Vestibular nerve, section of, via posterior fossa (H) (Anaes.) (Assist.)

1,310.60

39503

Faciohypoglossal nerve or facioaccessory nerve, anastomosis of (H) (Anaes.) (Assist.)

984.85

39600

Intracranial haemorrhage, burrhole craniotomy for—including burrholes (H) (Anaes.) (Assist.)

488.45

39603

Intracranial haemorrhage, osteoplastic craniotomy or extensive craniectomy and removal of haematoma (H) (Anaes.) (Assist.)

1,233.05

39606

Fractured skull, depressed or comminuted, operation for (H) (Anaes.) (Assist.)

822.00

39609

Fractured skull, compound, without dural penetration, operation for (H) (Anaes.) (Assist.)

984.85

39612

Fractured skull, compound, depressed or complicated, with dural penetration and brain laceration, operation for (H) (Anaes.) (Assist.)

1,155.50

39615

Fractured skull with rhinorrhoea or otorrhoea, repair of, by cranioplasty or endoscopic approach (H) (Anaes.) (Assist.)

1,233.05

39640

Tumour involving anterior cranial fossa, removal of, involving craniotomy, radical excision of the skull base, and dural repair (H) (Anaes.) (Assist.)

3,126.35

39642

Tumour involving anterior cranial fossa, removal of, involving frontal craniotomy with lateral rhinotomy for clearance of paranasal sinus extension, (intracranial procedure) (H) (Anaes.) (Assist.)

3,286.80

39646

Tumour involving anterior cranial fossa, removal of, involving frontal craniotomy with lateral rhinotomy and radical clearance of paranasal sinus and orbital fossa extensions, with intracranial decompression of the optic nerve, (intracranial procedure) (H) (Anaes.) (Assist.)

3,767.75

39650

Tumour involving middle cranial fossa and infratemporal fossa, removal of, craniotomy and radical or subtotal radical excision, with division and reconstruction of zygomatic arch, (intracranial procedure) (H) (Anaes.) (Assist.)

2,725.55

39653

Petroclival and clival tumour, removal of, by supra and infratentorial approaches for radical or subtotal radical excision (intracranial procedure), other than a service to which item 39654 or 39656 applies (H) (Anaes.) (Assist.)

4,850.10

39654

Petroclival and clival tumour, removal of, by supra and infratentorial approaches for radical or subtotal radical excision (intracranial procedure), conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

3,527.40

39656

Petroclival and clival tumour, removal of, by supra and infratentorial approaches for radical or subtotal radical excision (intracranial procedure), conjoint surgery, cosurgeon (H) (Assist.)

2,645.45

39658

Tumour involving the clivus, radical or subtotal radical excision of, involving transoral or transmaxillary approach (H) (Anaes.) (Assist.)

3,126.35

39660

Tumour or vascular lesion of cavernous sinus, radical excision of, involving craniotomy with or without intracranial carotid artery exposure (H) (Anaes.) (Assist.)

3,126.35

39662

Tumour or vascular lesion of foramen magnum, radical excision of, via transcondylar or far lateral suboccipital approach (H) (Anaes.) (Assist.)

3,126.35

39700

Skull tumour, benign or malignant, excision of, excluding cranioplasty (H) (Anaes.) (Assist.)

574.00

39703

Intracranial tumour, cyst or other brain tissue, burrhole and biopsy of, or drainage of, or both (H) (Anaes.) (Assist.)

535.20

39706

Intracranial tumour, biopsy or decompression of via osteoplastic flap or biopsy and decompression of via osteoplastic flap (H) (Anaes.) (Assist.)

1,147.60

39709

Craniotomy for removal of glioma, metastatic carcinoma or another tumour in cerebrum, cerebellum or brain stem—other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

1,636.35

39712

Craniotomy for removal of meningioma, pinealoma, craniopharyngioma, intraventricular tumour or another intracranial tumour—other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

2,954.50

39715

Pituitary tumour, removal of, by transcranial or transphenoidal approach (H) (Anaes.) (Assist.)

2,047.30

39718

Arachnoidal cyst, craniotomy for (H) (Anaes.) (Assist.)

899.55

39721

Craniotomy, involving osteoplastic flap, for reopening postoperatively for haemorrhage, swelling, etc. (H) (Anaes.) (Assist.)

822.00

39800

Aneurysm, clipping or reinforcement of sac (H) (Anaes.) (Assist.)

2,946.80

39803

Intracranial arteriovenous malformation, excision of (H) (Anaes.) (Assist.)

2,946.80

39806

Aneurysm, or arteriovenous malformation, intracranial proximal artery clipping of (H) (Anaes.) (Assist.)

1,325.90

39812

Intracranial aneurysm or arteriovenous fistula, ligation of cervical vessel or vessels (H) (Anaes.) (Assist.)

651.50

39815

Carotidcavernous fistula, obliteration of—combined cervical and intracranial procedure (Anaes.) (Assist.)

1,884.35

39818

Extracranial to intracranial bypass using superficial temporal artery (H) (Anaes.) (Assist.)

1,884.35

39821

Extracranial to intracranial bypass using saphenous vein graft (H) (Anaes.) (Assist.)

2,237.50

39900

Intracranial infection, drainage of, via burrhole—including burrhole (H) (Anaes.) (Assist.)

535.20

39903

Intracranial abscess, excision of (H) (Anaes.) (Assist.)

1,636.35

39906

Osteomyelitis of skull or removal of infected bone flap, craniectomy for (H) (Anaes.) (Assist.)

822.00

40000

Ventriculocisternostomy (Torkildsen’s operation) (H) (Anaes.) (Assist.)

946.10

40003

Cranial or cisternal shunt diversion, insertion of (H) (Anaes.) (Assist.)

946.10

40006

Lumbar shunt diversion, insertion of (H) (Anaes.) (Assist.)

744.50

40009

Cranial, cisternal or lumbar shunt, revision or removal of (H) (Anaes.) (Assist.)

542.80

40012

Third ventriculostomy (open or endoscopic) with or without endoscopic septum pellucidotomy (H) (Anaes.) (Assist.)

1,062.40

40015

Subtemporal decompression (H) (Anaes.) (Assist.)

658.60

40018

Lumbar cerebrospinal fluid drain, insertion of (Anaes.)

164.40

40100

Meningocele, excision and closure of (H) (Anaes.) (Assist.)

713.35

40103

Myelomeningocele, excision and closure of, including skin flaps or Z plasty, if performed (H) (Anaes.) (Assist.)

1,046.95

40106

ArnoldChiari malformation, decompression of (H) (Anaes.) (Assist.)

1,062.40

40109

Encephalocoele, excision and closure of (H) (Anaes.) (Assist.)

1,147.60

40112

Tethered cord, release of, including lipomeningocele or diastematomyelia (H) (Anaes.) (Assist.)

1,473.35

40115

Craniostenosis, operation for—single suture (H) (Anaes.) (Assist.)

744.50

40118

Craniostenosis, operation for—more than one suture (H) (Anaes.) (Assist.)

984.85

40600

Cranioplasty, reconstructive (H) (Anaes.) (Assist.)

984.85

40700

Corpus callosum, anterior section of, for epilepsy (H) (Anaes.) (Assist.)

1,799.15

40701

Vagus nerve stimulation therapy through stimulation of the left vagus nerve, subcutaneous placement of electrical pulse generator, for:

(a) management of refractory generalised epilepsy; or

(b) treatment of refractory focal epilepsy not suitable for resective epilepsy surgery

(H) (Anaes.) (Assist.)

351.25

40702

Vagus nerve stimulation therapy through stimulation of the left vagus nerve, surgical repositioning or removal of electrical pulse generator inserted for:

(a) management of refractory generalised epilepsy; or

(b) treatment of refractory focal epilepsy not suitable for resective epilepsy surgery

(H) (Anaes.) (Assist.)

164.40

40703

Corticectomy, topectomy or partial lobectomy for epilepsy (H) (Anaes.) (Assist.)

1,512.10

40704

Vagus nerve stimulation therapy through stimulation of the left vagus nerve, surgical placement of lead, including connection of lead to left vagus nerve and intraoperative test stimulation, for:

(a) management of refractory generalised epilepsy; or

(b) treatment of refractory focal epilepsy not suitable for resective epilepsy surgery

(H) (Anaes.) (Assist.)

695.20

40705

Vagus nerve stimulation therapy through stimulation of the left vagus nerve, surgical repositioning or removal of lead attached to left vagus nerve for:

(a) management of refractory generalised epilepsy; or

(b) treatment of refractory focal epilepsy not suitable for resective epilepsy surgery

(H) (Anaes.) (Assist.)

624.30

40706

Hemispherectomy for intractable epilepsy (Anaes.) (Assist.)

2,210.05

40707

Vagus nerve stimulation therapy through stimulation of the left vagus nerve, electrical analysis and programming of vagus nerve stimulation therapy device using external wand, for:

(a) management of refractory generalised epilepsy; or

(b) treatment of refractory focal epilepsy not suitable for resective epilepsy surgery

195.65

40708

Vagus nerve stimulation therapy through stimulation of the left vagus nerve, surgical replacement of battery in electrical pulse generator inserted for:

(a) management of refractory generalised epilepsy; or

(b) treatment of refractory focal epilepsy not suitable for resective epilepsy surgery

(H) (Anaes.) (Assist.)

351.25

40709

Burrhole placement of intracranial depth or surface electrodes (H) (Anaes.) (Assist.)

535.20

40712

Intracranial electrode placement via craniotomy (H) (Anaes.) (Assist.)

1,077.85

40800

Stereotactic anatomical localisation, as an independent procedure (Anaes.) (Assist.)

658.60

40801

Functional stereotactic procedure, including computer assisted anatomical localisation, physiological localisation and lesion production in the basal ganglia, brain stem or deep white matter tracts, other than a service associated with deep brain stimulation for Parkinson’s disease, essential tremor or dystonia (H) (Anaes.) (Assist.)

1,800.35

40803

Intracranial stereotactic procedure by any method, other than a service to which item 40800 or 40801 applies (Anaes.) (Assist.)

1,233.05

40850

Deep brain stimulation (unilateral) functional stereotactic procedure, including computer assisted anatomical localisation, physiological localisation including twist drill, burr hole craniotomy or craniectomy and insertion of electrodes for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

2,335.20

40851

Deep brain stimulation (bilateral) functional stereotactic procedure, including computer assisted anatomical localisation, physiological localisation including twist drill, burr hole craniotomy or craniectomy and insertion of electrodes for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

4,086.80

40852

Deep brain stimulation (unilateral) subcutaneous placement of neurostimulator receiver or pulse generator for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

351.25

40854

Deep brain stimulation (unilateral) revision or removal of brain electrode for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

542.80

40856

Deep brain stimulation (unilateral) removal or replacement of neurostimulator receiver or pulse generator for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

263.45

40858

Deep brain stimulation (unilateral) placement, removal or replacement of extension lead for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

542.80

40860

Deep brain stimulation (unilateral) target localisation incorporating anatomical and physiological techniques, including intraoperative clinical evaluation, for the insertion of a single neurostimulation wire for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia if the patient’s symptoms cause severe disability

(H) (Anaes.) (Assist.)

2,085.90

40862

Deep brain stimulation (unilateral) electronic analysis and programming of neurostimulator pulse generator for the treatment of:

(a) Parkinson’s disease, if the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or

(b) essential tremor or dystonia, if the patient’s symptoms cause severe disability

(Anaes.)

195.65

40903

Neuroendoscopy, for inspection of an intraventricular lesion, with or without biopsy including burrhole (H) (Anaes.) (Assist.)

571.85

40905

Craniotomy, performed in association with items 45767, 45776, 45782 and 45785 for the correction of craniofacial abnormalities (Anaes.)

620.50

Subgroup 8—Ear, nose and throat

41500

Ear, foreign body (other than ventilating tube) in, removal of, other than by simple syringing (Anaes.)

85.05

41501

Examination of glottal cycles and vibratory characteristics of the vocal folds, by a specialist in the practice of the specialist’s specialty of otolaryngology, using videostroboscopy (capturing audio, video, frequency and intensity), for confirmation of diagnosis, or for confirmation of treatment effectiveness where there is failure to progress or respond as expected, for:

(a) dysphonia, if nonstroboscopic techniques of visualising the larynx have failed to identify any frank abnormality of the vocal folds; or

(b) benign or malignant vocal fold lesions; or

(c) premalignant or malignant laryngeal lesions; or

(d) vocal fold motion impairment or glottal insufficiency; or

(e) evaluation of vocal fold function after treatment or phonosurgery;

other than a service associated with a service to which item 41764 applies, or a service associated with the administration of a general anaesthetic

191.40

41503

Ear, removal of foreign body in, involving incision of external auditory canal (Anaes.)

246.25

41506

Aural polyp, removal of (Anaes.)

148.50

41509

External auditory meatus, surgical removal of keratosis obturans from, other than a service to which another item in this Group applies (Anaes.)

168.05

41512

Meatoplasty involving removal of cartilage or bone or both cartilage and bone, other than a service to which item 41515 applies (H) (Anaes.) (Assist.)

604.20

41515

Meatoplasty involving removal of cartilage or bone or both cartilage and bone, being a service associated with a service to which item 41530, 41548, 41560 or 41563 applies (H) (Anaes.) (Assist.)

396.55

41518

External auditory meatus, removal of exostoses in (H) (Anaes.) (Assist.)

957.75

41521

Correction of auditory canal stenosis, including meatoplasty, with or without grafting (H) (Anaes.) (Assist.)

1,019.70

41524

Reconstruction of external auditory canal, being a service associated with a service to which items 41557, 41560 and 41563 apply (H) (Anaes.) (Assist.)

294.60

41527

Myringoplasty, transcanal approach (Rosen incision) (H) (Anaes.) (Assist.)

605.95

41530

Myringoplasty, postaural or endaural approach with or without mastoid inspection (H) (Anaes.)

987.20

41533

Atticotomy without reconstruction of the bony defect, with or without myringoplasty (H) (Anaes.) (Assist.)

1,180.05

41536

Atticotomy with reconstruction of the bony defect with or without myringoplasty (H) (Anaes.) (Assist.)

1,321.75

41539

Ossicular chain reconstruction (H) (Anaes.) (Assist.)

1,123.95

41542

Ossicular chain reconstruction and myringoplasty (H) (Anaes.) (Assist.)

1,231.55

41545

Mastoidectomy (cortical) (H) (Anaes.) (Assist.)

537.55

41548

Obliteration of the mastoid cavity (H) (Anaes.) (Assist.)

713.35

41551

Mastoidectomy, intact wall technique, with myringoplasty (H) (Anaes.) (Assist.)

1,642.85

41554

Mastoidectomy, intact wall technique, with myringoplasty and ossicular chain reconstruction (H) (Anaes.) (Assist.)

1,935.60

41557

Mastoidectomy (radical or modified radical) (H) (Anaes.) (Assist.)

1,123.95

41560

Mastoidectomy (radical or modified radical) and myringoplasty (H) (Anaes.)

1,231.55

41563

Mastoidectomy (radical or modified radical), myringoplasty and ossicular chain reconstruction (H) (Anaes.) (Assist.)

1,524.60

41564

Mastoidectomy (radical or modified radical), obliteration of the mastoid cavity, blind sac closure of external auditory canal and obliteration of eustachian tube (H) (Anaes.) (Assist.)

1,971.55

41566

Revision of mastoidectomy (radical, modified radical or intact wall), including myringoplasty (H) (Anaes.) (Assist.)

1,123.95

41569

Decompression of facial nerve in its mastoid portion (H) (Anaes.) (Assist.)

1,231.55

41572

Labyrinthotomy or destruction of labyrinth (H) (Anaes.) (Assist.)

1,065.50

41575

Cerebellopontine angle tumour, removal of by 2 surgeons operating conjointly, by transmastoid, translabyrinthine or retromastoid approach—transmastoid, translabyrinthine or retromastoid procedure (including aftercare) (H) (Anaes.) (Assist.)

2,511.75

41576

Cerebellopontine angle tumour, removal of, by transmastoid, translabyrinthine or retromastoid approach (intracranial procedure) (including aftercare) other than a service to which item 41578 or 41579 applies (H) (Anaes.) (Assist.)

3,767.75

41578

Cerebellopontine angle tumour, removal of, by transmastoid, translabyrinthine or retromastoid approach (intracranial procedure)—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

2,511.75

41579

Cerebellopontine angle tumour, removal of, by transmastoid, translabyrinthine or retromastoid approach (intracranial procedure)—conjoint surgery, cosurgeon (H) (Assist.)

1,883.85

41581

Tumour involving infraemporal fossa, removal of, involving craniotomy and radical excision of (H) (Anaes.) (Assist.)

2,889.05

41584

Partial temporal bone resection for removal of tumour involving mastoidectomy with or without decompression of facial nerve (H) (Anaes.) (Assist.)

1,982.70

41587

Total temporal bone resection for removal of tumour (H) (Anaes.) (Assist.)

2,700.40

41590

Endolymphatic sac, transmastoid decompression with or without drainage of (H) (Anaes.) (Assist.)

1,231.55

41593

Translabyrinthine vestibular nerve section (H) (Anaes.) (Assist.)

1,605.10

41596

Retrolabyrinthine vestibular nerve section or cochlear nerve section, or both (H) (Anaes.) (Assist.)

1,793.85

41599

Internal auditory meatus, exploration by middle cranial fossa approach with cranial nerve decompression (H) (Anaes.) (Assist.)

1,793.85

41603

Osseointegration procedure—implantation of titanium fixture for use with implantable bone conduction hearing system device, in a patient:

(a) with a permanent or long term hearing loss; and

(b) unable to utilise conventional air or bone conduction hearing aid for medical or audiological reasons; and

(c) with bone conduction thresholds that accord with recognised surgical criteria for the implantable bone conduction hearing system devices;

other than a service associated with a service to which item 41554, 45794 or 45797 applies

519.60

41604

Osseointegration procedure—fixation of transcutaneous abutment implantation of titanium fixture for use with implantable bone conduction hearing system device, in a patient:

(a) with a permanent or long term hearing loss; and

(b) unable to utilise conventional air or bone conduction hearing aid for medical or audiological reasons; and

(c) with bone conduction thresholds that accord with recognised surgical criteria for the implantable bone conduction hearing system devices;

other than a service associated with a service to which item 41554, 45794 or 45797 applies

192.35

41608

Stapedectomy (H) (Anaes.) (Assist.)

1,123.95

41611

Stapes mobilisation (H) (Anaes.) (Assist.)

723.20

41614

Round window surgery including repair of cochleotomy (Anaes.) (Assist.)

1,123.95

41615

Oval window surgery, including repair of fistula, other than a service associated with a service to which another item in this Group applies (Anaes.) (Assist.)

1,123.95

41617

Cochlear implant, insertion of, including mastoidectomy (H) (Anaes.) (Assist.)

1,954.40

41618

Middle ear implant, partially implantable, insertion of, via mastoidectomy, for patients with:

(a) stable sensorineural hearing loss; and

(b) outer ear pathology that prevents the use of a conventional hearing aid; and

(c) a PTA4 of less than 80 dBHL; and

(d) bilateral, symmetrical hearing loss with PTA thresholds in both ears within 20 dBHL (0.54kHz) of each other; and

(e) speech perception discrimination of at least 65% correct for word lists with appropriately amplified sound; and

(f) a normal middle ear; and

(g) normal tympanometry; and

(h) on audiometry, an airbone gap of less than 10 dBHL (0.54kHz) across all frequencies; and

(i) no other inner ear disorders

(H) (Anaes.) (Assist.)

1,935.60

41620

Glomus tumour, transtympanic removal of (H) (Anaes.) (Assist.)

850.30

41623

Glomus tumour, transmastoid removal of, including mastoidectomy (H) (Anaes.) (Assist.)

1,231.55

41626

Abscess or inflammation of middle ear, operation for (excluding aftercare) (Anaes.)

148.50

41629

Middle ear, exploration of (H) (Anaes.) (Assist.)

537.55

41632

Middle ear, insertion of tube for drainage of (including myringotomy) (Anaes.)

246.25

41635

Clearance of middle ear for granuloma, cholesteatoma and polyp, one or more, with or without myringoplasty (Anaes.) (Assist.)

1,180.05

41638

Clearance of middle ear for granuloma, cholesteatoma and polyp, one or more, with or without myringoplasty with ossicular chain reconstruction (H) (Anaes.) (Assist.)

1,472.95

41641

Perforation of tympanum, cauterisation or diathermy of (Anaes.)

48.90

41644

Excision of rim of eardrum perforation, other than a service associated with myringoplasty (Anaes.)

147.30

41647

Ear toilet requiring use of operating microscope and microinspection of tympanic membrane with or without general anaesthesia (Anaes.)

113.30

41650

Tympanic membrane, microinspection of one or both ears under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)

113.30

41653

Examination of nasal cavity or postnasal space or nasal cavity and postnasal space, under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)

74.20

41656

Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding aftercare) (Anaes.)

126.65

41659

Nose, removal of foreign body in, other than by simple probing (Anaes.)

80.00

41662

Nasal polyp or polypi (simple), removal of

85.05

41668

Nasal polyp or polypi, removal of (H) (Anaes.)

226.80

41671

Nasal septum, septoplasty, submucous resection or closure of septal perforation (H) (Anaes.)

498.35

41672

Nasal septum, reconstruction of (H) (Anaes.) (Assist.)

621.70

41674

Cauterisation (other than by chemical means) or cauterisation by chemical means when performed under general anaesthesia or diathermy of septum or turbinates—one or more of these procedures (including any consultation on the same occasion) other than a service associated with another operation on the nose (Anaes.)

103.65

41677

Nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)

92.80

41683

Division of nasal adhesions, with or without stenting other than a service associated with another operation on the nose and not performed during the postoperative period of a nasal operation (Anaes.)

120.90

41686

Dislocation of turbinate or turbinates, one or both sides, other than a service associated with a service to which another item in this Group applies (Anaes.)

74.20

41689

Turbinectomy or turbinectomies, partial or total, unilateral (H) (Anaes.)

140.80

41692

Turbinates, submucous resection of, unilateral (H) (Anaes.)

183.60

41698

Maxillary antrum, proof puncture and lavage of (Anaes.)

33.55

41701

Maxillary antrum, proof puncture and lavage of—under general anaesthesia, other than a service associated with a service to which another item in this Group applies (H) (Anaes.)

94.75

41704

Maxillary antrum, lavage of—each attendance at which the procedure is performed, including any associated consultation (Anaes.)

37.45

41707

Maxillary artery, transantral ligation of (H) (Anaes.) (Assist.)

462.60

41710

Antrostomy (radical) (H) (Anaes.) (Assist.)

537.55

41713

Antrostomy (radical) with transantral ethmoidectomy or transantral vidian neurectomy (H) (Anaes.) (Assist.)

625.45

41716

Antrum, intranasal operation on or removal of foreign body from (H) (Anaes.) (Assist.)

304.95

41719

Antrum, drainage of, through tooth socket (Anaes.)

121.25

41722

Oroantral fistula, plastic closure of (Anaes.) (Assist.)

605.95

41725

Ethmoidal artery or arteries, transorbital ligation of (unilateral) (H) (Anaes.) (Assist.)

462.60

41728

Lateral rhinotomy with removal of tumour (H) (Anaes.) (Assist.)

925.30

41729

Dermoid of nose, excision of, with intranasal extension (H) (Anaes.) (Assist.)

586.40

41731

Frontonasal ethmoidectomy by external approach with or without sphenoidectomy (H) (Anaes.) (Assist.)

801.40

41734

Radical frontoethmoidectomy with osteoplastic flap (H) (Anaes.) (Assist.)

1,045.70

41737

Frontal sinus, or ethmoidal sinuses on the one side, intranasal operation on (H) (Anaes.) (Assist.)

498.35

41740

Frontal sinus, catheterisation of (H) (Anaes.)

60.65

41743

Frontal sinus, trephine of (H) (Anaes.) (Assist.)

348.00

41746

Frontal sinus, radical obliteration of (Anaes.) (Assist.)

801.40

41749

Ethmoidal sinuses, external operation on (H) (Anaes.) (Assist.)

625.45

41752

Sphenoidal sinus, intranasal operation on (H) (Anaes.) (Assist.)

304.95

41755

Eustachian tube, catheterisation of (Anaes.)

47.95

41764

Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx and larynx, one or more of these procedures, unilateral or bilateral examination of (Anaes.)

126.65

41767

Nasopharyngeal angiofibroma, removal of (Anaes.) (Assist.)

760.05

41770

Pharyngeal pouch, removal of, with or without cricopharyngeal myotomy (H) (Anaes.) (Assist.)

723.20

41773

Pharyngeal pouch, endoscopic resection of (Dohlman’s operation) (H) (Anaes.) (Assist.)

605.95

41776

Cricopharyngeal myotomy with or without inversion of pharyngeal pouch (H) (Anaes.) (Assist.)

604.20

41779

Pharyngotomy (lateral), with or without total excision of tongue (H) (Anaes.) (Assist.)

723.20

41782

Partial pharyngectomy via pharyngotomy (Anaes.) (Assist.)

981.85

41785

Partial pharyngectomy via pharyngotomy with partial or total glossectomy (H) (Anaes.) (Assist.)

1,218.05

41786

Uvulopalatopharyngoplasty, with or without tonsillectomy, by any means (H) (Anaes.) (Assist.)

760.05

41787

Uvulectomy and partial palatectomy with laser incision of the palate, with or without tonsillectomy, one or more stages, including any revision procedures within 12 months (Anaes.) (Assist.)

586.40

41789

Tonsils or tonsils and adenoids, removal of, in a person aged less than 12 years (including any examination of the postnasal space and nasopharynx and the infiltration of local anaesthetic), not being a service to which item 41764 applies (H) (Anaes.)

304.95

41793

Tonsils or tonsils and adenoids, removal of, in a person 12 years of age or over (including any examination of the postnasal space and nasopharynx and the infiltration of local anaesthetic), not being a service to which item 41764 applies (H) (Anaes.)

383.10

41797

Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthesia, following removal of (H) (Anaes.)

148.50

41801

Adenoids, removal of (including any examination of the postnasal space and nasopharynx and the infiltration of local anaesthetic), not being a service to which item 41764 applies (H) (Anaes.)

168.05

41804

Lingual tonsil or lateral pharyngeal bands, removal of (H) (Anaes.)

92.80

41807

Peritonsillar abscess (quinsy), incision of (Anaes.)

72.25

41810

Uvulotomy or uvulectomy (Anaes.)

36.70

41813

Vallecular or pharyngeal cysts, removal of (H) (Anaes.) (Assist.)

367.50

41816

Oesophagoscopy (with rigid oesophagoscope) (Anaes.)

191.40

41822

Oesophagoscopy (with rigid oesophagoscope) with biopsy (H) (Anaes.)

246.25

41825

Oesophagoscopy (with rigid oesophagoscope) with removal of foreign body (H) (Anaes.) (Assist.)

367.50

41828

Oesophageal stricture, dilatation of, without oesophagoscopy (Anaes.)

53.85

41831

Oesophagus, endoscopic pneumatic dilatation of, for treatment of achalasia (Anaes.) (Assist.)

368.15

41832

Oesophagus, balloon dilatation of, using interventional imaging techniques (Anaes.)

235.65

41834

Laryngectomy (total) (H) (Anaes.) (Assist.)

1,329.45

41837

Vertical hemilaryngectomy including tracheostomy (H) (Anaes.) (Assist.)

1,274.70

41840

Supraglottic laryngectomy including tracheostomy (H) (Anaes.) (Assist.)

1,567.25

41843

Laryngopharyngectomy or primary restoration of alimentary continuity after laryngopharyngectomy using stomach or bowel (H) (Anaes.) (Assist.)

1,378.20

41855

Microlaryngoscopy (H) (Anaes.) (Assist.)

297.20

41858

Microlaryngoscopy with removal of juvenile papillomata (H) (Anaes.) (Assist.)

509.60

41861

Microlaryngoscopy with removal of benign lesions of the larynx by laser surgery (H) (Anaes.) (Assist.)

623.15

41864

Microlaryngoscopy with removal of tumour (H) (Anaes.) (Assist.)

420.20

41867

Microlaryngoscopy with arytenoidectomy (H) (Anaes.) (Assist.)

632.55

41868

Laryngeal web, division of, using microlarygoscopic techniques (H) (Anaes.)

400.80

41870

Injection of vocal cord by teflon, fat, collagen or gelfoam (H) (Anaes.) (Assist.)

469.10

41873

Larynx, fractured, operation for (Anaes.) (Assist.)

605.95

41876

Larynx, external operation on, or laryngofissure, with or without cordectomy (Anaes.) (Assist.)

605.95

41879

Laryngoplasty or tracheoplasty, including tracheostomy (H) (Anaes.) (Assist.)

981.85

41880

Tracheostomy by a percutaneous technique using sequential dilatation or partial splitting method to allow insertion of a cuffed tracheostomy tube (H) (Anaes.)

262.05

41881

Tracheostomy by open exposure of the trachea, including separation of the strap muscles or division of the thyroid isthmus, if performed (H) (Anaes.) (Assist.)

414.30

41884

Cricothyrostomy by direct stab or Seldinger technique, using mini tracheostomy device (H) (Anaes.)

93.90

41885

Tracheoesophageal fistula, formation of, as a secondary procedure following laryngectomy, including associated endoscopic procedures (Anaes.) (Assist.)

296.90

41886

Trachea, removal of foreign body in (Anaes.)

183.60

41889

Bronchoscopy, as an independent procedure (Anaes.)

183.60

41892

Bronchoscopy with one or more endobronchial biopsies or other diagnostic or therapeutic procedures (Anaes.)

242.40

41895

Bronchus, removal of foreign body in (H) (Anaes.) (Assist.)

379.25

41898

Fibreoptic bronchoscopy with one or more transbronchial lung biopsies, with or without bronchial or bronchoalveolar lavage, with or without the use of interventional imaging (Anaes.) (Assist.)

264.95

41901

Endoscopic laser resection of endobronchial tumours for relief of obstruction including any associated endoscopic procedures (H) (Anaes.) (Assist.)

623.15

41904

Bronchoscopy with dilatation of tracheal stricture (Anaes.)

254.20

41905

Trachea or bronchus, dilatation of stricture and endoscopic insertion of stent (H) (Anaes.) (Assist.)

467.50

41907

Nasal septum button, insertion of (Anaes.)

126.65

41910

Duct of major salivary gland, transposition of (H) (Anaes.) (Assist.)

402.45

Subgroup 9—Ophthalmology

42503

Ophthalmological examination under general anaesthesia, other than a service associated with a service to which another item in this Group applies (H) (Anaes.)

105.70

42504

Glaucoma, implantation of a microbypass surgery stent system into the trabecular meshwork, if:

(a) conservative therapies have failed, are likely to fail, or are contraindicated; and

(b) the service is performed by a specialist with training that is recognised by the Conjoint Committee for the Recognition of Training in MicroBypass Glaucoma Surgery (Anaes.)

310.15

42505

Complete removal from the eye of a transtrabecular drainage device or devices, with or without replacement, following devicerelated medical complications necessitating complete removal (Anaes.)

310.15

42506

Eye, enucleation of, with or without sphere implant (Anaes.) (Assist.)

496.30

42509

Eye, enucleation of, with insertion of integrated implant (H) (Anaes.) (Assist.)

628.10

42510

Eye, enucleation of, with insertion of hydroxy apatite implant or similar coralline implant (H) (Anaes.) (Assist.)

724.00

42512

Globe, evisceration of (Anaes.) (Assist.)

496.30

42515

Globe, evisceration of, and insertion of intrascleral ball or cartilage (H) (Anaes.) (Assist.)

628.10

42518

Anophthalmic orbit, insertion of cartilage or artificial implant as a delayed procedure, or removal of implant from socket, or placement of a motility integrating peg by drilling into existing orbital implant (H) (Anaes.) (Assist.)

364.40

42521

Anophthalmic socket, treatment of, by insertion of a wiredin conformer, integrated implant or dermofat graft, as a secondary procedure (H) (Anaes.) (Assist.)

1,240.80

42524

Orbit, skin graft to, as a delayed procedure (Anaes.)

210.95

42527

Contracted socket, reconstruction including mucous membrane grafting and stent mould (H) (Anaes.) (Assist.)

418.75

42530

Orbit, exploration with or without biopsy, requiring removal of bone (H) (Anaes.) (Assist.)

651.50

42533

Orbit, exploration of, with drainage or biopsy not requiring removal of bone (H) (Anaes.) (Assist.)

418.75

42536

Orbit, exenteration of, with or without skin graft and with or without temporalis muscle transplant (H) (Anaes.) (Assist.)

860.65

42539

Orbit, exploration of, with removal of tumour or foreign body, requiring removal of bone (H) (Anaes.) (Assist.)

1,225.30

42542

Orbit, exploration of anterior aspect with removal of tumour or foreign body (H) (Anaes.) (Assist.)

519.60

42543

Orbit, exploration of retrobulbar aspect with removal of tumour or foreign body (H) (Anaes.) (Assist.)

911.45

42545

Orbit, decompression of, for dysthyroid eye disease, by fenestration of 2 or more walls, or by the removal of intraorbital peribulbar and retrobulbar fat from each quadrant of the orbit, one eye (H) (Anaes.) (Assist.)

1,318.30

42548

Optic nerve meninges, incision of (H) (Anaes.) (Assist.)

783.10

42551

Eye, penetrating wound or rupture of, not involving intraocular structures—repair involving suture of cornea or sclera, or both, other than a service to which item 42632 applies (Anaes.) (Assist.)

651.50

42554

Eye, penetrating wound or rupture of, with incarceration or prolapse of uveal tissue—repair (H) (Anaes.) (Assist.)

760.05

42557

Eye, penetrating wound or rupture of, with incarceration of lens or vitreous—repair (H) (Anaes.) (Assist.)

1,062.40

42563

Intraocular foreign body, removal from anterior segment (Anaes.) (Assist.)

535.20

42569

Intraocular foreign body, removal from posterior segment (H) (Anaes.) (Assist.)

1,062.40

42572

Orbital abscess or cyst, drainage of (Anaes.)

121.05

42573

Dermoid, periorbital, excision of, on a person 10 years of age or over (Anaes.)

234.55

42574

Dermoid, orbital, excision of (Anaes.) (Assist.)

498.35

42575

Tarsal cyst, extirpation of (Anaes.)

85.30

42576

Dermoid, periorbital, excision of, on a person under 10 years of age (Anaes.)

304.95

42581

Ectropion or entropion, tarsal cauterisation of (Anaes.)

121.05

42584

Tarsorrhaphy (Anaes.) (Assist.)

285.45

42587

Trichiasis (due to causes other than trachoma), treatment of by cryotherapy, laser or electrolysis—each eyelid (Anaes.)

53.60

42588

Trichiasis (due to trachoma), treatment of by cryotherapy, laser or electrolysis—each eyelid (Anaes.)

53.60

42590

Canthoplasty, medial or lateral (Anaes.) (Assist.)

348.90

42593

Lacrimal gland, excision of palpebral lobe (H) (Anaes.)

210.95

42596

Lacrimal sac, excision of, or operation on (Anaes.) (Assist.)

519.60

42599

Lacrimal canalicular system, establishment of patency by closed operation using silicone tubes or similar, one eye (Anaes.) (Assist.)

651.50

42602

Lacrimal canalicular system, establishment of patency by open operation, one eye (Anaes.) (Assist.)

651.50

42605

Lacrimal canaliculus, immediate repair of (Anaes.) (Assist.)

480.65

42608

Lacrimal drainage by insertion of glass tube, as an independent procedure (Anaes.) (Assist.)

310.15

42610

Nasolacrimal tube (unilateral), removal or replacement of, or lacrimal passages, probing for obstruction, unilateral, with or without lavage—under general anaesthesia (Anaes.)

99.25

42611

Nasolacrimal tube (bilateral), removal or replacement of, or lacrimal passages, probing for obstruction, bilateral, with or without lavage—under general anaesthesia (Anaes.)

148.85

42614

Nasolacrimal tube (unilateral), removal or replacement of, or lacrimal passages, probing to establish patency of, or probing for obstruction (or both), unilateral, including lavage, other than a service associated with a service to which item 42610 applies (excluding aftercare)

49.80

42615

Nasolacrimal tube (bilateral), removal or replacement of, or lacrimal passages, probing for obstruction, bilateral, including lavage, other than a service associated with a service to which item 42611 applies (excluding aftercare)

74.50

42617

Punctum snip operation (Anaes.)

141.25

42620

Punctum, occlusion of, by use of a plug (Anaes.)

54.30

42622

Punctum, permanent occlusion of, by use of electrical cautery (Anaes.)

85.30

42623

Dacryocystorhinostomy (H) (Anaes.) (Assist.)

721.30

42626

Dacryocystorhinostomy if a previous dacryocystorhinostomy has been performed (Anaes.) (Assist.)

1,163.30

42629

Conjunctivorhinostomy including dacryocystorhinostomy and fashioning of conjunctival flaps (H) (Anaes.) (Assist.)

876.25

42632

Conjunctival peritomy or repair of corneal laceration by conjunctival flap (Anaes.)

121.05

42635

Corneal perforations, sealing of, with tissue adhesive (Anaes.) (Assist.)

310.15

42638

Conjunctival graft over cornea (Anaes.) (Assist.)

387.75

42641

Autoconjunctival transplant, or mucous membrane graft (Anaes.) (Assist.)

504.00

42644

Cornea or sclera, complete removal of embedded foreign body from—not more than once on the same day by the same practitioner (excluding aftercare) (Anaes.)

74.40

42647

Corneal scars, removal of, by partial keratectomy, other than a service associated with a service to which item 42686 applies (Anaes.)

210.95

42650

Cornea, epithelial debridement for corneal ulcer or corneal erosion (excluding aftercare) (Anaes.)

74.40

42651

Cornea, epithelial debridement for eliminating band keratopathy (Anaes.)

165.80

42652

Corneal collagen cross linking, on a person with a corneal ectatic disorder, with evidence of progression—per eye (Anaes.)

1,237.50

42653

Cornea, transplantation of (H) (Anaes.) (Assist.)

1,348.60

42656

Cornea, transplantation of, second and subsequent procedures (H) (Anaes.) (Assist.)

1,721.60

42662

Sclera, transplantation of, full thickness, including collection of donor material (H) (Anaes.) (Assist.)

930.50

42665

Sclera, transplantation of, superficial or lamellar, including collection of donor material (Anaes.) (Assist.)

620.45

42667

Running corneal suture, manipulation of, performed within 4 months of corneal grafting, to reduce astigmatism, if a reduction of 2 dioptres of astigmatism is obtained, including any associated consultation

146.35

42668

Corneal sutures, removal of, not earlier than 6 weeks after operation requiring use of slit lamp or operating microscope (Anaes.)

77.65

42672

Corneal incisions, to correct corneal astigmatism of more than 11/2 dioptres following anterior segment surgery, including appropriate measurements and calculations, performed as an independent procedure (Anaes.) (Assist.)

930.50

42673

Additional corneal incisions, to correct corneal astigmatism of more than 11/2 dioptres, including appropriate measurements and calculations, performed in conjunction with other anterior segment surgery (Anaes.) (Assist.)

465.15

42676

Conjunctiva, biopsy of, as an independent procedure

119.30

42677

Conjunctiva, cautery of, including treatment of pannus—each attendance at which treatment is given including any associated consultation (Anaes.)

62.90

42680

Conjunctiva, cryotherapy to, for melanotic lesions or similar using CO2 or N20 (Anaes.)

310.15

42683

Conjunctival cysts, removal of (H) (Anaes.)

124.15

42686

Pterygium, removal of (Anaes.)

282.20

42689

Pinguecula, removal of, other than a service associated with the fitting of contact lenses (Anaes.)

121.05

42692

Limbic tumour, removal of, excluding Pterygium (Anaes.) (Assist.)

285.45

42695

Limbic tumour, excision of, requiring keratectomy or sclerectomy, excluding Pterygium (Anaes.) (Assist.)

465.15

42698

Lens extraction, excluding surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye (Anaes.)

613.30

42701

Intraocular lens, insertion of, excluding surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye (Anaes.)

342.05

42702

Lens extraction and insertion of intraocular lens, excluding surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye (Anaes.)

784.40

42703

Intraocular lens or iris prosthesis, insertion of, into the posterior chamber with fixation to the iris or sclera (Anaes.) (Assist.)

589.90

42704

Intraocular lens, removal or repositioning of by open operation—other than a service associated with a service to which item 42701 applies (Anaes.)

480.65

42705

Lens extraction and insertion of intraocular lens, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye, performed in association with a transtrabecular drainage device or devices, in a patient diagnosed with open angle glaucoma who is not adequately responsive to topical antiglaucoma medications or who is intolerant of antiglaucoma medication (Anaes.)

939.60

42707

Intraocular lens, removal of and replacement with a different lens, excluding surgery performed to correct a refractive error, other than anisometropia that exceeds 3 dioptres and develops after the removal of cataract in the first eye (Anaes.)

822.00

42710

Intraocular lens, removal of, and replacement with a lens inserted into the posterior chamber and fixated to the iris or sclera (Anaes.) (Assist.)

930.50

42713

Iris suturing, McCannell technique or similar, for fixation of intraocular lens or repair of iris defect (Anaes.) (Assist.)

387.75

42716

Cataract, juvenile, removal of, including subsequent needlings (Anaes.) (Assist.)

1,233.05

42719

Either or both of the following, via a limbal approach by any method:

(a) removal of capsular or lens material;

(b) removal of vitreous;

other than a service associated with a service to which item 42698, 42702, 42705, 42716, 42725 or 42731 applies (Anaes.) (Assist.)

535.20

42725

Vitrectomy via pars plana sclerotomy, including one or more of the following:

(a) removal of vitreous;

(b) division of vitreous bands;

(c) removal of epiretinal membranes;

(d) capsulotomy

(H) (Anaes.) (Assist.)

1,380.25

42731

Limbal or pars plana lensectomy combined with vitrectomy, other than a service associated with item 42698, 42702, 42705, 42719 or 42725 (H) (Anaes.) (Assist.)

1,566.45

42734

Capsulotomy, other than by laser, and other than a service associated with a service to which item 42725 or 42731 applies (Anaes.) (Assist.)

310.15

42738

Paracentesis of anterior chamber or vitreous cavity, or both, for the injection of therapeutic substances, or the removal of aqueous or vitreous humours for diagnostic or therapeutic purposes, one or more of, as an independent procedure

310.15

42739

Paracentesis of anterior chamber or vitreous cavity, or both, for the injection of therapeutic substances, or the removal of aqueous or vitreous humours for diagnostic or therapeutic purposes, one or more of, as an independent procedure, for a patient requiring anaesthetic services (Anaes.)

310.15

42740

Intravitreal injection of therapeutic substances, or the removal of vitreous humour for diagnostic purposes, one or more of, as a procedure associated with other intraocular surgery (Anaes.)

310.15

42741

Posterior juxtascleral depot injection of a therapeutic substance, for the treatment of subfoveal choroidal neovascularisation due to agerelated macular degeneration, one or more of (Anaes.)

310.15

42743

Anterior chamber, irrigation of blood from, as an independent procedure (Anaes.) (Assist.)

651.50

42744

Needle revision of glaucoma filtration bleb, following glaucoma filtering procedure (Anaes.)

309.95

42746

Glaucoma, filtering operation for, if conservative therapies have failed, are likely to fail, or are contraindicated (H) (Anaes.) (Assist.)

984.85

42749

Glaucoma, filtering operation for, if previous filtering operation has been performed (H) (Anaes.) (Assist.)

1,233.05

42752

Glaucoma, insertion of drainage device incorporating an extraocular reservoir for, such as a Molteno device (H) (Anaes.) (Assist.)

1,380.25

42755

Glaucoma, removal of drainage device incorporating an extraocular reservoir for, such as a Molteno device (H) (Anaes.) (Assist.)

170.60

42758

Goniotomy for the treatment of primary congenital glaucoma, excluding the minimally invasive implantation of glaucoma drainage devices (H) (Anaes.) (Assist.)

721.30

42761

Division of anterior or posterior synechiae, as an independent procedure, other than by laser (Anaes.) (Assist.)

535.20

42764

Iridectomy (including excision of tumour of iris) or iridotomy, as an independent procedure, other than by laser (Anaes.) (Assist.)

535.20

42767

Tumour, involving ciliary body or ciliary body and iris, excision of (H) (Anaes.) (Assist.)

1,124.40

42770

Cyclodestructive procedures for the treatment of intractable glaucoma, treatment to one eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)

304.00

42773

Detached retina, pneumatic retinopexy for, other than a service associated with a service to which item 42776 applies (Anaes.) (Assist.)

930.50

42776

Detached retina, buckling or resection operation for (H) (Anaes.) (Assist.)

1,380.25

42779

Detached retina, revision of scleral buckling operation for (H) (Anaes.) (Assist.)

1,721.60

42782

Laser trabeculoplasty, for the treatment of glaucoma—each treatment to one eye, to a maximum of 4 treatments to that eye in a 2 year period (Anaes.) (Assist.)

465.15

42785

Laser iridotomy—each treatment episode to one eye, to a maximum of 3 treatments to that eye in a 2 year period (Anaes.) (Assist.)

364.40

42788

Laser capsulotomy—each treatment episode to one eye, to a maximum of 2 treatments to that eye in a 2 year period—other than a service associated with a service to which item 42702 applies (Anaes.) (Assist.)

364.40

42791

Laser vitreolysis or corticolysis of lens material or fibrinolysis, excluding vitreolysis in the posterior vitreous cavity—each treatment to one eye, to a maximum of 3 treatments to that eye in a 2 year period (Anaes.) (Assist.)

364.40

42794

Division of suture by laser following glaucoma filtration surgery, each treatment to one eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.)

69.80

42801

Episcleral radioactive plaque (Ruthenium 106 or Iodine 125), for the treatment of choroidal melanomas, insertion of (H) (Anaes.) (Assist.)

1,082.50

42802

Episcleral radioactive plaque (Ruthenium 106 or Iodine 125), for the treatment of choroidal melanomas, removal of (H) (Anaes.) (Assist.)

541.10

42805

Tantalum markers, surgical insertion to the sclera to localise the tumour base and to assist in planning radiotherapy of choroidal melanomas—one or more of (Anaes.)

604.85

42806

Iris tumour, laser photocoagulation of (Anaes.) (Assist.)

364.40

42807

Photomydriasis, laser

366.90

42808

Laser peripheral iridoplasty

366.90

42809

Retina, photocoagulation of, other than a service associated with photodynamic therapy with verteporfin (Anaes.) (Assist.)

465.15

42810

Phototherapeutic keratectomy, by laser, for corneal scarring or disease, excluding surgery for refractive error (Anaes.)

585.45

42811

Transpupillary thermotherapy, for choroidal and retinal tumours or vascular malformations (Anaes.)

465.15

42812

Removal of scleral buckling material, from an eye having undergone previous scleral buckling surgery (Anaes.)

170.60

42815

Vitreous cavity, removal of silicone oil or other liquid vitreous substitutes from, during a procedure other than that in which the vitreous substitute is inserted (H) (Anaes.) (Assist.)

651.50

42818

Retina, cryotherapy to, as an independent procedure, or when performed in association with item 42770 or 42809 (Anaes.)

604.85

42821

Ocular transillumination, for the diagnosis and measurement of intraocular tumours (Anaes.)

93.20

42824

Retrobulbar injection of alcohol or other drug, as an independent procedure

72.05

42833

Squint, operation for, on one or both eyes, the operation involving a total of one or 2 muscles on a patient aged 15 years or over (H) (Anaes.) (Assist.)

604.85

42836

Squint, operation for, on one or both eyes, the operation involving a total of one or 2 muscles:

(a) on a patient aged 14 years or under; or

(b) if the patient has had previous squint, retinal or extra ocular operations on the eye or eyes; or

(c) on a patient with concurrent thyroid eye disease (H) (Anaes.) (Assist.)

752.20

42839

Squint, operation for, on one or both eyes, the operation involving a total of 3 or more muscles on a patient aged 15 years or over (H) (Anaes.) (Assist.)

721.30

42842

Squint, operation for, on one or both eyes, the operation involving a total of 3 or more muscles:

(a) on a patient aged 14 years or under; or

(b) if the patient has had previous squint, retinal or extra ocular operations on the eye or eyes; or

(c) on a patient with concurrent thyroid eye disease (H) (Anaes.) (Assist.)

899.55

42845

Readjustment of adjustable sutures, one or both eyes, as an independent procedure following an operation for correction of squint (Anaes.)

195.35

42848

Squint, muscle transplant for (Hummelsheim type, or similar operation) on a patient aged 15 years or over (H) (Anaes.) (Assist.)

721.30

42851

Squint, muscle transplant for (Hummelsheim type, or similar operation) on a patient who:

(a) is aged 14 years or under; or

(b) has had previous squint, retinal or extraocular operations on the patient’s eye or eyes; or

(c) has concurrent thyroid eye disease (H) (Anaes.) (Assist.)

899.55

42854

Ruptured medial palpebral ligament or ruptured extraocular muscle, repair of (Anaes.) (Assist.)

418.75

42857

Resuturing of wound following intraocular procedures with or without excision of prolapsed iris (Anaes.) (Assist.)

418.75

42860

Eyelid (upper or lower), scleral or Goretex or other nonautogenous graft to, with recession of the lid retractors (Anaes.) (Assist.)

930.50

42863

Eyelid, recession of (Anaes.) (Assist.)

798.75

42866

Entropion or tarsal ectropion, repair of, by tightening, shortening or repair of inferior retractors by open operation across the entire width of the eyelid (Anaes.) (Assist.)

775.35

42869

Eyelid closure in facial nerve paralysis, insertion of foreign implant for (Anaes.) (Assist.)

566.15

42872

Eyebrow, elevation of, by skin excision, to correct for a reduced field of vision caused by paretic, involutional, or traumatic eyebrow descent/ptosis to a position below the superior orbital rim (Anaes.)

248.20

43021

Photodynamic therapy, one eye, including the infusion of vertoporfin continuously through a peripheral vein, using a nonthermal laser at a wavelength of 689 nm, for the treatment of choroidal neovascularisation

469.30

43022

Photodynamic therapy, both eyes, including the infusion of vertoporfin continuously through a peripheral vein, using a nonthermal laser at a wavelength of 689 nm, for the treatment of choroidal neovascularisation

563.20

43023

Infusion of vertoporfin for discontinued photodynamic therapy, if a session of therapy that would have been provided under item 43021 or 43022 has been discontinued on medical grounds

91.25

Subgroup 10—Operations for osteomyelitis

43500

Operation on phalanx (for acute osteomyelitis) (H) (Anaes.)

127.20

43503

Operation on sternum, clavicle, rib, ulna, radius, carpus, tibia, fibula, tarsus, skull, mandible or maxilla (other than alveolar margins) (for acute osteomyelitis)—one bone (H) (Anaes.)

211.10

43506

Operation on humerus or femur (for acute osteomyelitis)—one bone (H) (Anaes.) (Assist.)

367.50

43509

Operation on spine or pelvic bones (for acute osteomyelitis)—one bone (H) (Anaes.) (Assist.)

367.50

43512

Operation on scapula, sternum, clavicle, rib, ulna, radius, metacarpus, carpus, phalanx, tibia, fibula, metatarsus, tarsus, mandible or maxilla (other than alveolar margins) (for chronic osteomyelitis)—one bone or any combination of adjoining bones (H) (Anaes.) (Assist.)

367.50

43515

Operation on humerus or femur (for chronic osteomyelitis)—one bone (Anaes.) (Assist.)

367.50

43518

Operation on spine or pelvic bones (for chronic osteomyelitis)—one bone (H) (Anaes.) (Assist.)

605.95

43521

Operation on skull (for chronic osteomyelitis) (H) (Anaes.) (Assist.)

479.05

43524

Operation on any combination of adjoining bones, being bones referred to in item 43515, 43518 or 43521 (for chronic osteomyelitis) (Anaes.) (Assist.)

605.95

Subgroup 11—Paediatric

43801

Intestinal malrotation with or without volvulus, laparotomy for, not involving bowel resection (H) (Anaes.) (Assist.)

987.20

43804

Intestinal malrotation with or without volvulus, laparotomy for, with bowel resection and anastomosis, with or without formation of stoma (H) (Anaes.) (Assist.)

1,051.10

43805

Umbilical, epigastric or linea alba hernia, repair of, on a person under 10 years of age (H) (Anaes.)

367.50

43807

Duodenal atresia or stenosis, duodenoduodenostomy or duodenojejunostomy for (H) (Anaes.) (Assist.)

1,146.75

43810

Jejunal atresia, bowel resection and anastomosis for, with or without tapering (H) (Anaes.) (Assist.)

1,337.85

43813

Meconium ileus, laparotomy for, complicated by one or more of associated volvulus, atresia, intestinal perforation with or without meconium peritonitis (H) (Anaes.) (Assist.)

1,337.85

43816

Ileal atresia, colonic atresia or meconium ileus other than a service associated with a service to which item 43813 applies, laparotomy for (H) (Anaes.) (Assist.)

1,242.20

43819

Aganglionosis Coli, laparotomy for, with or without frozen section biopsies and formation of stoma (H) (Anaes.) (Assist.)

1,003.35

43822

Anorectal malformation, laparotomy and colostomy for (H) (Anaes.) (Assist.)

1,003.35

43825

Neonatal alimentary obstruction, laparotomy for, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)

1,146.75

43828

Acute neonatal necrotising enterocolitis, laparotomy for, with resection, including any anastomoses or stoma formation (H) (Anaes.) (Assist.)

1,266.90

43831

Acute neonatal necrotising enterocolitis, if no definitive procedure is possible, laparotomy for (H) (Anaes.) (Assist.)

987.20

43832

Branchial fistula, removal of, on a person under 10 years of age (H) (Anaes.) (Assist.)

673.35

43834

Bowel resection for necrotising enterocolitis stricture or strictures, including any anastomoses or stoma formation (H) (Anaes.) (Assist.)

1,146.75

43835

Strangulated, incarcerated or obstructed hernia, repair of, without bowel resection, on a person under 10 years of age (H) (Anaes.) (Assist.)

698.85

43837

Congenital diaphragmatic hernia, repair by thoracic or abdominal approach, with diagnosis confirmed in the first 24 hours of life (H) (Anaes.) (Assist.)

1,433.35

43838

Diaphragmatic hernia, congenital, repair of, by thoracic or abdominal approach, on a person under 10 years of age, not being a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)

1,283.35

43840

Congenital diaphragmatic hernia, repair by thoracic or abdominal approach, diagnosed after the first day of life and before 20 days of age (H) (Anaes.) (Assist.)

1,242.20

43841

Femoral or inguinal hernia or infantile hydrocele, repair of, on a person under 10 years of age, other than a service to which item 30403 or 43835 applies (H) (Anaes.) (Assist.)

622.70

43843

Oesophageal atresia (with or without repair of tracheooesophageal fistula), complete correction of, other than a service to which item 43846 applies (H) (Anaes.) (Assist.)

1,911.25

43846

Oesophageal atresia (with or without repair of tracheooesophageal fistula), complete correction of, in infant of birth weight less than 1,500 g (H) (Anaes.) (Assist.)

2,054.55

43849

Oesophageal atresia, gastrostomy for (H) (Anaes.) (Assist.)

525.55

43852

Oesophageal atresia, thoracotomy for, and division of tracheooesophageal fistula without anastomosis (H) (Anaes.) (Assist.)

1,672.20

43855

Oesophageal atresia, delayed primary anastomosis for (H) (Anaes.) (Assist.)

1,767.95

43858

Oesophageal atresia, cervical oesophagostomy for (H) (Anaes.) (Assist.)

621.10

43861

Congenital cystadenomatoid malformation or congenital lobar emphysema, thoracotomy and lung resection for (H) (Anaes.) (Assist.)

1,720.15

43864

Gastroschisis, operation for (H) (Anaes.) (Assist.)

1,290.10

43867

Gastroschisis or exomphalos, secondary operation for, with removal of silo (H) (Anaes.) (Assist.)

716.70

43870

Exomphalos containing small bowel only, operation for (H) (Anaes.) (Assist.)

1,003.35

43873

Exomphalos containing small bowel and other viscera, operation for (H) (Anaes.) (Assist.)

1,337.85

43876

Sacrococcygeal teratoma, excision of, by posterior approach (H) (Anaes.) (Assist.)

1,146.75

43879

Sacrococcygeal teratoma, excision of, by combined posterior and abdominal approach (H) (Anaes.) (Assist.)

1,337.85

43882

Cloacal exstrophy, operation for (Anaes.) (Assist.)

1,720.15

43900

Tracheooesophageal fistula without atresia, division and repair of (H) (Anaes.) (Assist.)

1,146.75

43903

Oesophageal atresia or corrosive oesophageal stricture, oesophageal replacement for, utilising gastric tube, jejunum or colon (H) (Anaes.) (Assist.)

1,911.25

43906

Oesophagus, resection of congenital, anastomic or corrosive stricture and anastomosis, other than a service to which item 43903 applies (H) (Anaes.) (Assist.)

1,672.20

43909

Tracheomalacia, aortopexy for (H) (Anaes.) (Assist.)

1,672.20

43912

Thoracotomy and excision of one or more of bronchogenic or enterogenous cyst or mediastinal teratoma (H) (Anaes.) (Assist.)

1,579.85

43915

Eventration, plication of diaphragm for (H) (Anaes.) (Assist.)

1,194.50

43930

Hypertrophic pyloric stenosis, pyloromyotomy for (H) (Anaes.) (Assist.)

459.35

43933

Idiopathic intussusception, laparotomy and manipulative reduction of (H) (Anaes.) (Assist.)

537.70

43936

Intussusception, laparotomy and resection with anastomosis (H) (Anaes.) (Assist.)

1,003.35

43939

Ventral hernia following neonatal closure of exomphalos or gastroschisis, repair of (H) (Anaes.) (Assist.)

764.45

43942

Abdominal wall vitello intestinal remnant, excision of (H) (Anaes.)

238.95

43945

Patent vitello intestinal duct, excision of (H) (Anaes.) (Assist.)

1,003.35

43948

Umbilical granuloma, excision of, under general anaesthesia (H) (Anaes.)

143.45

43951

Gastrooesophageal reflux with or without hiatus hernia, laparotomy and fundoplication for, without gastrostomy (H) (Anaes.) (Assist.)

898.55

43954

Gastrooesophageal reflux with or without hiatus hernia, laparotomy and fundoplication for, with gastrostomy (H) (Anaes.) (Assist.)

1,099.05

43957

Gastrooesophageal reflux, laparotomy and fundoplication for, with or without hiatus hernia, in child with neurological disease, with gastrostomy (H) (Anaes.) (Assist.)

1,194.50

43960

Anorectal malformation, perineal anoplasty of (H) (Anaes.) (Assist.)

420.20

43963

Anorectal malformation, posterior sagittal anorectoplasty of (H) (Anaes.) (Assist.)

1,672.20

43966

Anorectal malformation, posterior sagittal anorectoplasty of, with laparotomy (H) (Anaes.) (Assist.)

1,911.25

43969

Persistent cloaca, total correction of, with genital repair using posterior sagittal approach, with or without laparotomy (H) (Anaes.) (Assist.)

2,627.95

43972

Choledochal cyst, resection of, with one duct anastomosis (H) (Anaes.) (Assist.)

1,911.25

43975

Choledochal cyst, resection of, with 2 duct anastomoses (H) (Anaes.) (Assist.)

2,245.75

43978

Biliary atresia, portoenterostomy for (H) (Anaes.) (Assist.)

1,911.25

43981

Nephroblastoma, neuroblastoma or other malignant tumour, laparotomy (exploratory), including associated biopsies, if no other intraabdominal procedure is performed (H) (Anaes.) (Assist.)

525.55

43984

Nephroblastoma, radical nephrectomy for (H) (Anaes.) (Assist.)

1,337.85

43987

Neuroblastoma, radical excision of (H) (Anaes.) (Assist.)

1,481.30

43990

Aganglionosis Coli, definitive resection with pullthrough anastomosis, with or without frozen section biopsies, when aganglionic segment extends to sigmoid colon (H) (Anaes.) (Assist.)

1,815.75

43993

Aganglionosis Coli, definitive resection with pullthrough anastomosis, with or without frozen section biopsies, when aganglionic segment extends into descending or transverse colon with or without resiting of stoma (H) (Anaes.) (Assist.)

1,959.00

43996

Aganglionosis Coli, total colectomy for total colonic aganglionosis with ileoanal pullthrough, with or without side to side ileocolonic anastomosis (H) (Anaes.) (Assist.)

2,197.95

43999

Aganglionosis Coli, anal sphincterotomy as an independent procedure for (H) (Anaes.) (Assist.)

274.85

44101

Rectum, examination of, under general anaesthesia with full thickness biopsy or removal of polyp or similar lesion, on a person under 2 years of age (H) (Anaes.) (Assist.)

344.50

44102

Rectum, examination of, under general anaesthesia with full thickness biopsy or removal of polyp or similar lesion, on a person 2 years of age or over (H) (Anaes.) (Assist.)

264.95

44104

Rectal prolapse, submucosal or perirectal injection for, under general anaesthesia, on a person under 2 years of age (Anaes.)

60.50

44105

Rectal prolapse, submucosal or perirectal injection for, under general anaesthesia, on a person 2 years of age or over (Anaes.)

46.50

44108

Inguinal hernia repair at age less than 12 months (H) (Anaes.) (Assist.)

506.80

44111

Obstructed or strangulated inguinal hernia, repair of, at age less than 12 months, including orchidopexy when performed (Anaes.) (Assist.)

593.60

44114

Inguinal hernia repair at age less than 12 months when orchidopexy also required (H) (Anaes.) (Assist.)

593.60

44130

Lymphadenectomy, for atypical mycobacterial infection or other granulomatous disease (Anaes.) (Assist.)

477.75

44133

Torticollis, open division of sternomastoid muscle for (H) (Anaes.) (Assist.)

379.25

44136

Ingrown toe nail, operation for, under general anaesthesia (Anaes.)

174.80

 

Subdivision ESubgroups 12 and 13 of Group T8

5.10.20  Meaning of amount under clause 5.10.20

  In item 44376:

amount under clause 5.10.20 means an amount equal to 75% of the fee mentioned for the item relating to an original amputation (any of items 44325 to 44373) of the body part for which the reamputation is performed.

5.10.21  Meaning of NOSE Scale

  In this Schedule:

NOSE Scale means the Nasal Obstruction Symptom Evaluation Scale, developed by Stewart et al, as published in OtolaryngologyHead and Neck Surgery, 130: 2, as existing on 1 July 2020.

5.10.22  Meaning of maxilla

  In items 45720 to 45752:

maxilla includes the zygoma.

5.10.23  Items in Subgroups 12 and 13 of Group T8

  This clause sets out items in Subgroups 12 and 13 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 12—Amputations

44325

Hand, midcarpal or transmetacarpal, amputation of (Anaes.) (Assist.)

304.95

44328

Hand, forearm or through arm, amputation of (H) (Anaes.) (Assist.)

367.50

44331

Amputation at shoulder (H) (Anaes.) (Assist.)

605.95

44334

Interscapulothoracic amputation (Anaes.) (Assist.)

1,231.55

44338

One digit of foot, amputation of (Anaes.)

148.50

44342

2 digits of one foot, amputation of (H) (Anaes.)

226.80

44346

3 digits of one foot, amputation of (H) (Anaes.) (Assist.)

261.90

44350

4 digits of one foot, amputation of (H) (Anaes.) (Assist.)

297.20

44354

5 digits of one foot, amputation of (H) (Anaes.) (Assist.)

340.15

44358

Toe, including metatarsal or part of metatarsal—each toe, amputation of (H) (Anaes.)

189.65

44359

One or more toes of one foot, amputation of, including if performed, excision of one or more metatarsal bones of the foot, performed for diabetic or other microvascular disease, excluding aftercare (H) (Anaes.) (Assist.)

272.15

44361

Foot at ankle (Syme, Pirogoff types), amputation of (H) (Anaes.) (Assist.)

367.50

44364

Foot, midtarsal or transmetatarsal, amputation of (H) (Anaes.) (Assist.)

304.95

44367

Amputation through thigh, at knee or below knee (H) (Anaes.) (Assist.)

538.25

44370

Amputation at hip (H) (Anaes.) (Assist.)

742.70

44373

Hindquarter, amputation of (Anaes.) (Assist.)

1,524.60

44376

Amputation stump, reamputation of, to provide adequate skin and muscle cover (Anaes.) (Assist.)

Amount under clause 5.10.20

Subgroup 13—Plastic and reconstructive surgery

45000

Single stage local muscle flap repair, on eyelid, nose, lip, neck, hand, thumb, finger or genitals—not in association with any of items 31356 to 31376 (Anaes.)

558.25

45003

Single stage local myocutaneous flap repair to one defect, simple and small—not in association with any of items 31356 to 31376 (Anaes.)

620.45

45006

Single stage large myocutaneous flap repair to one defect (pectoralis major, latissimus dorsi, or similar large muscle) (H) (Anaes.) (Assist.)

1,070.05

45009

Single stage local muscle flap repair to one defect, simple and small (H) (Anaes.) (Assist.)

390.90

45012

Single stage large muscle flap repair to one defect (pectoralis major, gastrocnemius, gracilis or similar large muscle) (H) (Anaes.) (Assist.)

654.85

45015

Muscle or myocutaneous flap, delay of (H) (Anaes.)

310.15

45018

Dermis, dermofat or fascia graft (excluding transfer of fat by injection), if the service is not associated with neurosurgical services for spinal disorders mentioned in any of items 51011 to 51171 (Anaes.) (Assist.)

488.45

45019

Full face chemical peel for severely sundamaged skin, if:

(a) the damage affects at least 75% of the facial skin surface area; and

(b) the damage involves photodamage (dermatoheliosis); and

(c) the photodamage involves:

(i) a solar keratosis load exceeding 30 individual lesions; or

(ii) solar lentigines; or

(iii) freckling, yellowing or leathering of the skin; or

(iv) solar kertoses which have proven refractory to, or recurred following, medical therapies; and

(d) at least medium depth peeling agents are used; and

(e) the chemical peel is performed in the operating theatre of a hospital by a medical practitioner recognised as a specialist in the specialty of dermatology or plastic surgery.

Applicable once only in any 12 month period (H) (Anaes.)

409.10

45021

Abrasive therapy for severely disfiguring scarring resulting from trauma, burns or acne—limited to one aesthetic area (Anaes.)

182.90

45024

Abrasive therapy for severely disfiguring scarring resulting from trauma, burns or acne—more than one aesthetic area (Anaes.)

411.00

45025

Carbon dioxide laser or erbium laser resurfacing of the face or neck for severely disfiguring scarring resulting from trauma, burns or acne (not including fractional laser therapy)—limited to one aesthetic area (Anaes.)

182.90

45026

Carbon dioxide laser or erbium laser resurfacing of the face or neck for severely disfiguring scarring resulting from trauma, burns or acne (not including fractional laser therapy)—more than one aesthetic area (Anaes.)

411.00

45027

Angioma, cauterisation of or injection into, if undertaken in the operating theatre of a hospital (Anaes.)

124.15

45030

Angioma (haemangioma or lymphangioma or both) of skin and subcutaneous tissue (excluding facial muscle or breast) or mucous surface, small, excision and suture of (Anaes.)

133.25

45033

Angioma (haemangioma or lymphangioma or both), large or involving deeper tissue including facial muscle or breast, excision and suture of (Anaes.)

248.20

45035

Angioma (haemangioma or lymphangioma or both) large and deep, involving muscles or nerves, excision of (H) (Anaes.) (Assist.)

724.00

45036

Angioma (haemangioma or lymphangioma or both) of neck, deep, excision of (H) (Anaes.) (Assist.)

1,163.30

45039

Arteriovenous malformation (3 cm or less) of superficial tissue, excision of (Anaes.)

248.20

45042

Arteriovenous malformation, (greater than 3 cm), excision of (Anaes.) (Assist.)

318.05

45045

Arteriovenous malformation on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals, excision of (Anaes.)

318.05

45048

Lymphoedematous tissue or lymphangiectasis, of lower leg and foot, or thigh, or upper arm, or forearm and hand, major excision of (H) (Anaes.) (Assist.)

798.75

45051

Contour reconstruction by open repair of contour defects, due to deformity, if:

(a) contour reconstructive surgery is indicated because the deformity is secondary to congenital absence of tissue or has arisen from trauma (other than trauma from previous cosmetic surgery); and

(b) insertion of a nonbiological implant is required, other than one or more of the following:

(i) insertion of a nonbiological implant that is a component of another service specified in Group T8;

(ii) injection of liquid or semisolid material;

(iii) an oral and maxillofacial implant service to which item 52321 applies;

(iv) a service to insert mesh; and

(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

488.55

45054

Limb or chest, decompression escharotomy of (including all incisions), for acute compartment syndrome secondary to burn (H) (Anaes.) (Assist.)

253.80

45060

 

Developmental breast abnormality, single stage correction of, if:

(a) the correction involves either:

(i) bilateral mastopexy for symmetrical tubular breasts; or

(ii) surgery on both breasts with a combination of insertion of one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least 20% in normally shaped breasts, or 10% in tubular breasts or in breasts with abnormally high inframammary folds; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

1,311.00

45061

 

Developmental breast abnormality, 2 stage correction of, first stage, involving surgery on both breasts with a combination of insertion of one or more tissue expanders, mastopexy or reduction mammaplasty, if:

(a) there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least:

(i) 20% in normally shaped breasts; or

(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes.

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

1,311.00

45062

Developmental breast abnormality, 2 stage correction of, second stage, involving surgery on both breasts with a combination of exchange of one or more tissue expanders for one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if:

(a) there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least:

(i) 20% in normally shaped breasts; or

(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes.

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

948.70

45200

Single stage local flap, if indicated to repair one defect, simple and small, excluding flap for male pattern baldness and excluding Hflap or double advancement flap—not in association with any of items 31356 to 31376 (Anaes.)

293.25

45201

Muscle, myocutaneous or skin flap, if clinically indicated to repair one surgical excision made in the removal of a malignant or nonmalignant skin lesion (only in association with items 31000, 31001, 31002, 31003, 31004, 31005, 31358, 31359, 31360, 31363, 31364, 31369, 31370, 31371, 31373 or 31376)—may be claimed only once per defect (Anaes.)

426.85

45202

Muscle, myocutaneous or skin flap, if clinically indicated to repair one surgical excision made in the removal of a malignant or nonmalignant skin lesion in a patient, if the clinical relevance of the procedure is clearly annotated in the patient’s record and either:

(a) item 45201 applies and additional flap repair is required for the same defect; or

(b) item 45201 does not apply and either:

(i) the patient has severe preexisting scarring, severe skin atrophy or sclerodermoid changes; or

(ii) the repair is contiguous with a free margin

(Anaes.)

426.85

45203

Single stage local flap, if indicated to repair one defect, complicated or large, excluding flap for male pattern baldness and excluding Hflap or double advancement flap—not in association with any of items 31356 to 31376 (Anaes.) (Assist.)

418.75

45206

Single stage local flap if indicated to repair one defect, on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals and excluding Hflap or double advancement flap—not in association with any of items 31356 to 31376 (Anaes.)

395.55

45207

Hflap or double advancement flap if indicated to repair one defect, on eyelid, eyebrow or forehead—not in association with any of items 31356 to 31376 (Anaes.)

395.55

45209

Direct flap repair (cross arm, abdominal or similar), first stage (Anaes.) (Assist.)

488.55

45212

Direct flap repair (cross arm, abdominal or similar), second stage (Anaes.)

242.40

45215

Direct flap repair, cross leg, first stage (H) (Anaes.) (Assist.)

1,045.70

45218

Direct flap repair, cross leg, second stage (H) (Anaes.) (Assist.)

469.10

45221

Direct flap repair, small (cross finger or similar), first stage (Anaes.)

269.75

45224

Direct flap repair, small (cross finger or similar), second stage (Anaes.)

121.25

45227

Indirect flap or tubed pedicle, formation of (Anaes.) (Assist.)

459.35

45230

Direct or indirect flap or tubed pedicle, delay of (Anaes.)

229.70

45233

Indirect flap or tubed pedicle, preparation of intermediate or final site and attachment to the site (Anaes.) (Assist.)

488.55

45236

Indirect flap or tubed pedicle, spreading of pedicle, as a separate procedure (H) (Anaes.)

383.10

45239

Direct, indirect or local flap, revision of, by incision and suture, other than a service to which item 45240 applies (Anaes.)

269.75

45240

Direct, indirect or local flap, revision of, by liposuction, other than a service to which item 45239, 45497, 45498 or 45499 applies (Anaes.)

269.75

45400

Free grafting (split skin) of a granulating area, small (Anaes.)

211.10

45403

Free grafting (split skin) of a granulating area, extensive (Anaes.) (Assist.)

420.20

45406

Free grafting (split skin) to burns, including excision of burnt tissue—involving not more than 3% of total body surface (Anaes.) (Assist.)

465.15

45409

Free grafting (split skin) to burns, including excision of burnt tissue—involving 3% or more but less than 6% of total body surface (H) (Anaes.) (Assist.)

620.45

45412

Free grafting (split skin) to burns, including excision of burnt tissue—involving 6% or more but less than 9% of total body surface (H) (Anaes.) (Assist.)

853.15

45415

Free grafting (split skin) to burns, including excision of burnt tissue—involving 9% or more but less than 12% of total body surface (H) (Anaes.) (Assist.)

930.50

45418

Free grafting (split skin) to burns, including excision of burnt tissue—involving 12% or more but less than 15% of total body surface (H) (Anaes.) (Assist.)

1,008.10

45439

Free grafting (split skin) to one defect, including elective dissection, small (Anaes.)

293.25

45442

Free grafting (split skin) to one defect, including elective dissection, extensive (Anaes.) (Assist.)

604.85

45445

Free grafting (split skin) as inlay graft to one defect including elective dissection using a mould (including insertion of and removal of mould) (Anaes.) (Assist.)

574.00

45448

Free grafting (split skin) to one defect, including elective dissection on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals, other than a service to which item 45442 or 45445 applies (Anaes.)

387.75

45451

Free grafting (full thickness) to one defect, excluding grafts for male pattern baldness (Anaes.) (Assist.)

488.55

45460

Free grafting (split skin) to burns, including excision of burnt tissue, involving 15% or more but less than 20% of total body surface—one surgeon (H) (Anaes.) (Assist.)

1,292.45

45461

Free grafting (split skin) to burns, including excision of burnt tissue, involving 15% or more but less than 20% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

921.15

45462

Free grafting (split skin) to burns, including excision of burnt tissue, involving 15% or more but less than 20% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

695.10

45464

Free grafting (split skin) to burns, including excision of burnt tissue, involving 20% or more but less than 30% of total body surface—one surgeon (H) (Anaes.) (Assist.)

1,972.85

45465

Free grafting (split skin) to burns, including excision of burnt tissue, involving 20% or more but less than 30% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

1,405.55

45466

Free grafting (split skin) to burns, including excision of burnt tissue, involving 20% or more but less than 30% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

1,060.05

45468

Free grafting (split skin) to burns, including excision of burnt tissue, involving 30% or more but less than 40% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

1,889.90

45469

Free grafting (split skin) to burns, including excision of burnt tissue, involving 30% or more but less than 40% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

1,425.85

45471

Free grafting (split skin) to burns, including excision of burnt tissue, involving 40% or more but less than 50% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

2,375.60

45472

Free grafting (split skin) to burns, including excision of burnt tissue, involving 40% or more but less than 50% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

1,791.90

45474

Free grafting (split skin) to burns, including excision of burnt tissue, involving 50% or more but less than 60% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

2,859.90

45475

Free grafting (split skin) to burns, including excision of burnt tissue, involving 50% or more but less than 60% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

2,157.85

45477

Free grafting (split skin) to burns, including excision of burnt tissue, involving 60% or more but less than 70% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

3,344.30

45478

Free grafting (split skin) to burns, including excision of burnt tissue, involving 60% or more but less than 70% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

2,522.50

45480

Free grafting (split skin) to burns, including excision of burnt tissue, involving 70% or more but less than 80% of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

3,828.60

45481

Free grafting (split skin) to burns, including excision of burnt tissue, involving 70% or more but less than 80% of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

2,888.60

45483

Free grafting (split skin) to burns, including excision of burnt tissue, involving 80% or more of total body surface—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

4,362.10

45484

Free grafting (split skin) to burns, including excision of burnt tissue, involving 80% or more of total body surface—conjoint surgery, cosurgeon (H) (Assist.)

3,291.20

45485

Free grafting (split skin) to burns, including excision of burnt tissue—upper eyelid, nose, lip, ear or palm of the hand (H) (Anaes.) (Assist.)

544.20

45486

Free grafting (split skin) to burns, including excision of burnt tissue—forehead, cheek, anterior aspect of the neck, chin, plantar aspect of the foot, heel or genitalia (H) (Anaes.) (Assist.)

465.15

45487

Free grafting (split skin) to burns, including excision of burnt tissue—whole of toe (Anaes.) (Assist.)

418.75

45488

Free grafting (split skin) to burns, including excision of burnt tissue—the whole of one digit of the hand (H) (Anaes.) (Assist.)

465.15

45489

Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 2 digits of the hand (H) (Anaes.) (Assist.)

697.95

45490

Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 3 digits of the hand (H) (Anaes.) (Assist.)

930.70

45491

Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 4 digits of the hand (H) (Anaes.) (Assist.)

1,163.30

45492

Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 5 digits of the hand (H) (Anaes.) (Assist.)

1,395.90

45493

Free grafting (split skin) to burns, including excision of burnt tissue—portion of digit of hand (H) (Anaes.) (Assist.)

418.75

45494

Free grafting (split skin) to burns, including excision of burnt tissue—whole of face (excluding ears) (H) (Anaes.) (Assist.)

1,689.85

45496

Flap, free tissue transfer using microvascular techniques—revision of, by open operation (H) (Anaes.)

429.05

45497

Flap, free tissue transfer using microvascular techniques or any breast reconstruction—complete revision of, by liposuction (H) (Anaes.)

335.10

45498

Flap, free tissue transfer using microvascular techniques or any breast reconstruction—staged revision of, by liposuction (first stage) (H) (Anaes.)

269.75

45499

Flap, free tissue transfer using microvascular techniques or any breast reconstruction—staged revision of, by liposuction (second stage) (H) (Anaes.)

201.05

45500

Microvascular repair using microsurgical techniques, with restoration of continuity of artery or vein of distal extremity or digit (H) (Anaes.) (Assist.)

1,124.40

45501

Microvascular anastomosis of artery using microsurgical techniques, for reimplantation of limb or digit (H) (Anaes.) (Assist.)

1,830.15

45502

Microvascular anastomosis of vein using microsurgical techniques, for reimplantation of limb or digit (H) (Anaes.) (Assist.)

1,830.15

45503

Microarterial or microvenous graft using microsurgical techniques (H) (Anaes.) (Assist.)

2,093.80

45504

Microvascular anastomosis of artery using microsurgical techniques, for free transfer of tissue including setting in of free flap (H) (Anaes.) (Assist.)

1,830.15

45505

Microvascular anastomosis of vein using microsurgical techniques, for free transfer of tissue including setting in of free flap (H) (Anaes.) (Assist.)

1,830.15

45506

Scar, of face or neck, not more than 3 cm in length, revision of, if:

(a) undertaken in the operating theatre of a hospital; or

(b) performed by a specialist in the practice of the specialist’s specialty (Anaes.)

226.80

45512

Scar, of face or neck, more than 3 cm in length, revision of, if:

(a) undertaken in the operating theatre of a hospital; or

(b) performed by a specialist in the practice of the specialist’s specialty (Anaes.)

304.95

45515

Scar, other than on face or neck, not more than 7 cm in length, revision of, as an independent procedure, if:

(a) undertaken in the operating theatre of a hospital; or

(b) performed by a specialist in the practice of the specialist’s specialty (Anaes.)

192.35

45518

Scar, other than on face or neck, more than 7 cm in length, revision of, as an independent procedure, if:

(a) undertaken in the operating theatre of a hospital; or

(b) performed by a specialist in the practice of the specialist’s speciality (Anaes.)

232.75

45519

Extensive burn scars of skin (more than 1% of body surface area), excision of, for correction of scar contracture (H) (Anaes.) (Assist.)

442.45

45520

Reduction mammaplasty (unilateral) with surgical repositioning of nipple, in the context of breast cancer or developmental abnormality of the breast (H) (Anaes.) (Assist.)

928.55

45522

Reduction mammaplasty (unilateral) without surgical repositioning of the nipple:

(a) excluding the treatment of gynaecomastia; and

(b) not with insertion of any prosthesis

(H) (Anaes.) (Assist.)

651.50

45523

Reduction mammaplasty (bilateral) with surgical repositioning of the nipple:

(a) for patients with macromastia and experiencing pain in the neck or shoulder region; and

(b) not with insertion of any prosthesis

(H) (Anaes.) (Assist.)

1,392.90

45524

Mammaplasty, augmentation (unilateral) in the context of:

(a) breast cancer; or

(b) developmental abnormality of the breast, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least:

(i) 20% in normally shaped breasts; or

(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds.

Applicable only once per occasion on which the service is provided

(H) (Anaes.) (Assist.)

764.80

45527

Breast reconstruction (unilateral), following mastectomy, using a permanent prosthesis (H) (Anaes.) (Assist.)

764.80

45528

Mammaplasty, augmentation, bilateral (other than a service to which item 45527 applies), if:

(a) reconstructive surgery is indicated because of:

(i) developmental malformation of breast tissue (excluding hypomastia); or

(ii) disease of or trauma to the breast (other than trauma resulting from previous elective cosmetic surgery); or

(iii) amastia secondary to a congenital endocrine disorder; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

1,147.10

45530

Breast reconstruction (unilateral), using a latissimus dorsi or other large muscle or myocutaneous flap, including repair of secondary skin defect, if required, excluding repair of muscular aponeurotic layer, other than a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177 or 30179 applies (H) (Anaes.) (Assist.)

1,133.75

45533

Breast reconstruction using breast sharing technique (first stage) including breast reduction, transfer of complex skin and breast tissue flap, split skin graft to pedicle of flap and other similar procedures (H) (Anaes.) (Assist.)

1,283.95

45536

Breast reconstruction using breast sharing technique (second stage) including division of pedicle, insetting of breast flap, with closure of donor site or other similar procedure (H) (Anaes.) (Assist.)

472.20

45539

Breast reconstruction (unilateral), following mastectomy, using tissue expansion—insertion of tissue expansion unit and all attendances for subsequent expansion injections (H) (Anaes.) (Assist.)

1,104.70

45542

Breast reconstruction (unilateral), following mastectomy, using tissue expansion—removal of tissue expansion unit and insertion of permanent prosthesis (H) (Anaes.) (Assist.)

632.55

45545

Nipple or areola or both, reconstruction of, by any surgical technique (Anaes.) (Assist.)

642.00

45546

Nipple or areola or both, intradermal colouration of, following breast reconstruction after mastectomy or for congenital absence of nipple

204.00

45548

Breast prosthesis, removal of, as an independent procedure (Anaes.)

285.45

45551

Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report (H) (Anaes.) (Assist.)

457.55

45553

Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if:

(a) either:

(i) it is demonstrated by intraoperative photographs postremoval that removal alone would cause unacceptable deformity; or

(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

589.45

45554

Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if:

(a) either:

(i) it is demonstrated by intraoperative photographs postremoval that removal alone would cause unacceptable deformity; or

(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and

(b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and

(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

721.30

45556

Breast ptosis, correction of (unilateral), in the context of breast cancer or developmental abnormality, if photographic evidence (including anterior, left lateral and right lateral views) and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)

789.95

45558

Breast ptosis, correction by mastopexy of (bilateral), if:

(a) at least twothirds of the breast tissue, including the nipple, lies inferior to the inframammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and

(b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and

(c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes

Applicable only once per lifetime (H) (Anaes.) (Assist.)

1,184.85

45560

Hair transplantation for the treatment of alopecia of congenital or traumatic origin or due to disease, excluding male pattern baldness, other than a service to which another item in this Group applies (Anaes.)

488.45

45561

Microvascular anastomosis of artery or vein using microsurgical techniques, for supercharging of pedicled flaps (H) (Anaes.) (Assist.)

1,830.15

45562

Free transfer of tissue involving raising of tissue on vascular or neurovascular pedicle, including direct repair of secondary cutaneous defect if performed, excluding flap for male pattern baldness (Anaes.) (Assist.)

1,133.75

45563

Neurovascular island flap, including direct repair of secondary cutaneous defect if performed, excluding flap for male pattern baldness (Anaes.) (Assist.)

1,133.75

45564

Free transfer of tissue reconstructive surgery for the repair of major tissue defect due to congenital deformity, surgery or trauma, involving anastomoses of up to 2 vessels using microvascular techniques and including raising of tissue on a vascular or neurovascular pedicle, preparation of recipient vessels, transfer of tissue, insetting of tissue at recipient site and direct repair of secondary cutaneous defect if performed, other than a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies—conjoint surgery, principal specialist surgeon (H) (Anaes.) (Assist.)

2,625.85

45565

Free transfer of tissue reconstructive surgery for the repair of major tissue defect due to congenital deformity, surgery or trauma, involving anastomoses of up to 2 vessels using microvascular techniques and including raising of tissue on a vascular or neurovascular pedicle, preparation of recipient vessels, transfer of tissue, insetting of tissue at recipient site and direct repair of secondary cutaneous defect if performed, other than a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies—conjoint surgery, conjoint specialist surgeon (H) (Assist.)

1,969.45

45566

Tissue expansion other than a service to which item 45539 or 45542 applies—insertion of tissue expansion unit and all attendances for subsequent expansion injections (H) (Anaes.) (Assist.)

1,104.70

45568

Tissue expander, removal of, with complete excision of fibrous capsule (H) (Anaes.) (Assist.)

457.55

45569

Closure of abdomen with reconstruction of umbilicus, with or without lipectomy, being a service associated with items 45562, 45530, 45564 or 45565 (H) (Anaes.) (Assist.)

698.80

45570

Closure of abdomen, repair of musculoaponeurotic layer, being a service associated with item 45569 (Anaes.) (Assist.)

943.55

45572

Intraoperative tissue expansion performed during an operation when combined with a service to which another item in Group T8 applies including expansion injections and excluding treatment of male pattern baldness (Anaes.)

300.80

45575

Facial nerve paralysis, free fascia graft for (Anaes.) (Assist.)

742.70

45578

Facial nerve paralysis, muscle transfer for (H) (Anaes.) (Assist.)

860.10

45581

Facial nerve palsy, excision of tissue for (Anaes.)

285.45

45584

Liposuction (suction assisted lipolysis) to one regional area (one limb or trunk), for treatment of posttraumatic pseudolipoma, if photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes (H) (Anaes.)

651.50

45585

Liposuction (suction assisted lipolysis) to one regional area (one limb or trunk), other than a service associated with a service to which item 31525 applies, if:

(a) the liposuction is for:

(i) the treatment of BarraquerSimons syndrome, lymphoedema or macrodystrophia lipomatosa; or

(ii) the reduction of a buffalo hump that is secondary to an endocrine disorder or pharmacological treatment of a medical condition; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.)

651.50

45587

Meloplasty for correction of facial asymmetry if:

(a) the asymmetry is secondary to trauma (including previous surgery), a congenital condition or a medical condition (such as facial nerve palsy); and

(b) the meloplasty is limited to one side of the face

(H) (Anaes.) (Assist.)

918.70

45588

Meloplasty (excluding browlifts and chinlift platysmaplasties), bilateral, if:

(a) surgery is indicated to correct a functional impairment due to a congenital condition, disease (excluding postacne scarring) or trauma (other than trauma resulting from previous elective cosmetic surgery); and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

1,378.15

45590

Orbital cavity, reconstruction of a wall or floor, with or without foreign implant (H) (Anaes.) (Assist.)

498.35

45593

Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (H) (Anaes.) (Assist.)

585.40

45596

Maxilla, total resection of (H) (Anaes.) (Assist.)

928.55

45597

Maxilla, total resection of both maxillae (H) (Anaes.) (Assist.)

1,243.05

45599

Mandible, total resection of both sides, including condylectomies, if performed (Anaes.) (Assist.)

965.80

45602

Mandible, including lower border, or maxilla, subtotal resection of (H) (Anaes.) (Assist.)

721.30

45605

Mandible or maxilla, segmental resection of, for tumours or cysts (H) (Anaes.) (Assist.)

605.95

45608

Mandible, hemimandibular reconstruction with bone graft, other than a service associated with a service to which item 45599 applies (H) (Anaes.) (Assist.)

853.15

45611

Mandible, condylectomy (H) (Anaes.) (Assist.)

488.55

45614

Eyelid, whole thickness reconstruction of, other than by direct suture only (Anaes.) (Assist.)

605.95

45617

Upper eyelid, reduction of, if:

(a) the reduction is for any of the following:

(i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid;

(ii) herniation of orbital fat in exophthalmos;

(iii) facial nerve palsy;

(iv) posttraumatic scarring;

(v) the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (iv); and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.)

242.40

45620

Lower eyelid, reduction of, if:

(a) the reduction is for:

(i) herniation of orbital fat in exophthalmos, facial nerve palsy or posttraumatic scarring; or

(ii) the restoration of symmetry of the contralateral lower eyelid in respect of one of these conditions; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.)

336.20

45623

Ptosis of upper eyelid (unilateral), correction of, by:

(a) sutured elevation of the tarsal plate on the eyelid retractors (Muller’s or levator muscle or levator aponeurosis); or

(b) sutured suspension to the brow/frontalis muscle

Not applicable to a service for repair of mechanical ptosis to which item 45617 applies

(Anaes.) (Assist.)

745.60

45624

Ptosis of upper eyelid, correction of, by:

(a) sutured elevation of the tarsal plate on the eyelid retractors (Muller’s or levator muscle or levator aponeurosis); or

(b) sutured suspension to the brow/frontalis muscle;

if a previous ptosis surgery has been performed on that side

(Anaes.) (Assist.)

966.70

45625

Ptosis of eyelid, correction of eyelid height by revision of levator sutures within one week of primary repair by levator resection or advancement, performed in the operating theatre of a hospital (H) (Anaes.)

193.40

45626

Ectropion or entropion (due to causes other than trachoma), correction of (unilateral) (Anaes.)

336.20

45627

Ectropion or entropion (due to trachoma), correction of (unilateral) (Anaes.)

336.20

45629

Symblepharon, grafting for (Anaes.) (Assist.)

488.55

45632

Rhinoplasty, partial, involving correction of lateral or alar cartilages, if:

(a) the indication for surgery is:

(i) airway obstruction and the patient has a selfreported NOSE Scale score of greater than 45; or

(ii) significant acquired, congenital or developmental deformity; and

(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.)

527.95

45635

Rhinoplasty, partial, involving correction of bony vault only, if:

(a) the indication for surgery is:

(i) airway obstruction and the patient has a selfreported NOSE Scale score of greater than 45; or

(ii) significant acquired, congenital or developmental deformity; and

(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.)

605.95

45641

Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if:

(a) the indication for surgery is:

(i) airway obstruction and the patient has a selfreported NOSE Scale score of greater than 45; or

(ii) significant acquired, congenital or developmental deformity; and

(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.)

1,099.30

45644

Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from distant donor site, including obtaining of graft, if:

(a) the indication for surgery is:

(i) airway obstruction and the patient has a selfreported NOSE Scale score of greater than 45; or

(ii) significant acquired, congenital or developmental deformity; and

(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

1,319.40

45645

Choanal atresia, repair of by puncture and dilatation (H) (Anaes.)

230.60

45646

Choanal atresia, correction by open operation with bone removal (Anaes.) (Assist.)

928.55

45647

Face, contour restoration of one region, using autogenous bone or cartilage graft (other than a service to which item 45644 applies) (H) (Anaes.) (Assist.)

1,319.40

45650

Rhinoplasty, revision of, if:

(a) the indication for surgery is:

(i) airway obstruction and the patient has a selfreported NOSE Scale score of greater than 45; or

(ii) significant acquired, congenital or developmental deformity; and

(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.)

152.40

45652

Rhinophyma of a moderate or severe degree, carbon dioxide laser or erbium laser excision—ablation of (Anaes.)

367.50

45653

Rhinophyma, shaving of (Anaes.)

367.50

45656

Composite graft (chondrocutaneous or chondromucosal) to nose, ear or eyelid (Anaes.) (Assist.)

517.95

45659

Correction of a congenital deformity of the ear if:

(a) the patient is less than 18 years of age; and

(b) the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; and

(c) photographic evidence demonstrating the clinical need for this service is documented in the patient notes

(H) (Anaes.) (Assist.)

537.55

45660

External ear, complex total reconstruction of, using multiple costal cartilage grafts to form a framework, including the harvesting and sculpturing of the cartilage and its insertion, for congenital absence, microtia or posttraumatic loss of entire or substantial portion of pinna (first stage)—performed by a specialist in the practice of the specialist’s specialty (H) (Anaes.) (Assist.)

2,968.65

45661

External ear, complex total reconstruction of, elevation of costal cartilage framework using cartilage previously stored in abdominal wall, including the use of local skin and fascia flaps and full thickness skin graft to cover cartilage (second stage)—performed by a specialist in the practice of the specialist’s specialty (H) (Anaes.) (Assist.)

1,319.40

45662

Congenital atresia, reconstruction of external auditory canal (H) (Anaes.) (Assist.)

723.20

45665

Lip, eyelid or ear, full thickness wedge excision of, with repair by direct sutures (Anaes.)

336.20

45668

Vermilionectomy, by surgical excision (Anaes.)

336.20

45669

Vermilionectomy for biopsyconfirmed cellular atypia, using carbon dioxide laser or erbium laser excision—ablation (Anaes.)

336.20

45671

Lip or eyelid reconstruction using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)

860.10

45674

Lip or eyelid reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)

250.15

45675

Macrocheilia or macroglossia, operation for (H) (Anaes.) (Assist.)

498.35

45676

Macrostomia, operation for (H) (Anaes.) (Assist.)

593.25

45677

Cleft lip, unilateral—primary repair, one stage, without anterior palate repair (H) (Anaes.) (Assist.)

558.25

45680

Cleft lip, unilateral—primary repair, one stage, with anterior palate repair (H) (Anaes.) (Assist.)

697.95

45683

Cleft lip, bilateral—primary repair, one stage, without anterior palate repair (H) (Anaes.) (Assist.)

775.35

45686

Cleft lip, bilateral—primary repair, one stage, with anterior palate repair (H) (Anaes.) (Assist.)

915.25

45689

Cleft lip, lip adhesion procedure, unilateral or bilateral (H) (Anaes.) (Assist.)

269.95

45692

Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)

310.15

45695

Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (H) (Anaes.) (Assist.)

504.00

45698

Cleft lip, primary columella lengthening procedure, bilateral (H) (Anaes.)

473.10

45701

Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (H) (Anaes.) (Assist.)

853.15

45704

Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)

310.15

45707

Cleft palate, primary repair (H) (Anaes.) (Assist.)

806.35

45710

Cleft palate, secondary repair, closure of fistula using local flaps (H) (Anaes.)

504.00

45713

Cleft palate, secondary repair, lengthening procedure (H) (Anaes.) (Assist.)

574.00

45714

Oronasal fistula, plastic closure of, including services to which item 45200, 45203 or 45239 applies (H) (Anaes.) (Assist.)

806.35

45716

Velopharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (H) (Anaes.)

806.35

45720

Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site, excluding services to which item 47933 or 47936 applies (Anaes.) (Assist.)

997.00

45723

Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,124.40

45726

Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,270.55

45729

Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,426.90

45731

Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the one jaw, including transposition of nerves and vessels and bone grafts taken from the same site, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,446.55

45732

Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the one jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,628.50

45735

Mandible and maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,661.40

45738

Mandible and maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,869.00

45741

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of one jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,827.65

45744

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of one jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

2,054.95

45747

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty (when performed) and transposition of nerves and vessels and bone grafts taken from the same site, excluding services to which item 47933 or 47936 applies (Anaes.) (Assist.)

1,993.95

45752

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

2,233.40

45753

Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (MalarMaxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

2,246.65

45754

Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (MalarMaxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.) (Assist.)

2,693.20

45755

Temporomandibular partial or total meniscectomy (Anaes.) (Assist.)

379.25

45758

Temporomandibular joint, arthroplasty (H) (Anaes.) (Assist.)

678.65

45761

Genioplasty, including transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

772.05

45767

Hypertelorism, correction of, intracranial (Anaes.) (Assist.)

2,590.15

45770

Hypertelorism, correction of, subcranial (H) (Anaes.) (Assist.)

1,984.00

45773

Treacher Collins Syndrome, periorbital correction of, with rib and iliac bone grafts (Anaes.) (Assist.)

1,808.15

45776

Orbital dystopia (unilateral), correction of, with total repositioning of one orbit, intracranial (H) (Anaes.) (Assist.)

1,808.15

45779

Orbital dystopia (unilateral), correction of, with total repositioning of one orbit, extracranial (H) (Anaes.) (Assist.)

1,329.45

45782

Frontoorbital advancement, unilateral (Anaes.) (Assist.)

1,016.45

45785

Cranial vault reconstruction for oxycephaly, brachycephaly, turricephaly or similar condition—(bilateral frontoorbital advancement) (H) (Anaes.) (Assist.)

1,720.20

45788

Glenoid fossa, zygomatic arch and temporal bone, reconstruction of, (Obwegeser technique) (H) (Anaes.) (Assist.)

1,700.65

45791

Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (H) (Anaes.) (Assist.)

918.70

45794

Osseointegration procedure—extraoral, implantation of titanium fixture, not for implantable bone conduction hearing system device (Anaes.)

519.60

45797

Osseointegration procedure, fixation of transcutaneous abutment, not for implantable bone conduction hearing system device (Anaes.)

192.35

45799

Aspiration biopsy of one or more jaw cysts as an independent procedure to obtain material for diagnostic purposes, other than a service associated with an operative procedure on the same day (Anaes.)

30.35

45801

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, if the removal is by surgical excision and suture, other than a service to which item 45803 applies (Anaes.)

130.90

45803

Tumour, cyst, ulcers or scar (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, if the removal is by surgical excision and suture, and the procedure is performed on more than 3 but not more than 10 lesions (Anaes.) (Assist.)

336.20

45805

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, more than 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane (Anaes.)

177.90

45807

Tumour, cyst (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5 mm separation between the cyst lining and tooth structure or if a tumour or cyst has been proven by positive histopathology), ulcer or scar (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, removal of, other than a service to which another item in this Subgroup applies, involving muscle, bone, or other deep tissue (Anaes.)

254.20

45809

Tumour or deep cyst (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5 mm separation between the cyst lining and tooth structure or if a tumour or cyst has been proven by positive histopathology), in the oral and maxillofacial region, removal of, requiring wide excision, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)

383.10

45811

Tumour, in the oral and maxillofacial region, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (Anaes.) (Assist.)

517.95

45813

Tumour, in the oral and maxillofacial region, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (Anaes.) (Assist.)

605.95

45815

Operation on mandible or maxilla (other than alveolar margins) for chronic osteomyelitis—one bone or in combination with adjoining bones (Anaes.) (Assist.)

367.50

45817

Operation on skull for osteomyelitis (Anaes.) (Assist.)

479.05

45819

Operation on any combination of adjoining bones in the oral and maxillofacial region, being bones referred to in item 45817 (Anaes.) (Assist.)

605.90

45821

Bone growth stimulator in the oral and maxillofacial region, insertion of (Anaes.) (Assist.)

392.70

45823

Arch bars, one or more, that were inserted for dental fixation purposes to the maxilla or mandible, removal of, requiring general anaesthesia, if undertaken in the operating theatre of a hospital (H) (Anaes.)

112.30

45825

Mandibular or palatal exostosis, excision of (Anaes.) (Assist.)

348.90

45827

Mylohyoid ridge, reduction of (Anaes.) (Assist.)

333.50

45829

Maxillary tuberosity, reduction of (Anaes.)

254.40

45831

Papillary hyperplasia of the palate, removal of—less than 5 lesions (Anaes.) (Assist.)

333.50

45833

Papillary hyperplasia of the palate, removal of—5 to 20 lesions (Anaes.) (Assist.)

418.75

45835

Papillary hyperplasia of the palate, removal of—more than 20 lesions (Anaes.) (Assist.)

519.60

45837

Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed—unilateral or bilateral (Anaes.) (Assist.)

604.85

45839

Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed—unilateral (Anaes.) (Assist.)

604.85

45841

Alveolar ridge augmentation with bone or alloplast or both—unilateral (Anaes.) (Assist.)

488.45

45843

Alveolar ridge augmentation—unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region (Anaes.) (Assist.)

299.60

45845

Osseointegration procedure—intraoral implantation of titanium fixture to facilitate restoration of the dentition following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)

519.60

45847

Osseointegration procedure—fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)

192.35

45849

Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes.) (Assist.)

599.05

45851

Temporomandibular joint, manipulation of, performed in the operating theatre of a hospital, other than a service associated with a service to which another item in this Subgroup applies (H) (Anaes.)

147.45

45853

Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)

918.70

45855

Temporomandibular joint, arthroscopy of, with or without biopsy, other than a service associated with another arthroscopic procedure of that joint (Anaes.) (Assist.)

421.50

45857

Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions—one or more of such procedures, other than a service associated with another arthroscopic procedure of the temporomandibular joint (Anaes.) (Assist.)

674.20

45859

Temporomandibular joint, arthrotomy of, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)

339.85

45861

Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)

899.55

45863

Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)

997.20

45865

Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (Anaes.) (Assist.)

299.60

45867

Temporomandibular joint, synovectomy of, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)

322.05

45869

Temporomandibular joint, open surgical exploration of, with or without meniscus or capsular surgery, including partial or total meniscectomy when performed, with or without microsurgical techniques (Anaes.) (Assist.)

1,225.30

45871

Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)

1,380.25

45873

Temporomandibular joint, surgery of, involving procedures to which item 45863, 45867, 45869 or 45871 applies and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (Anaes.) (Assist.)

1,551.00

45875

Temporomandibular joint, stabilisation of, involving one or more of: repair of capsule, repair of ligament or internal fixation, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)

485.40

45877

Temporomandibular joint, arthrodesis of, with synovectomy if performed, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)

485.40

45879

Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)

322.05

45882

Treatment of a premalignant lesion of the oral mucosa using cryotherapy, diathermy or carbon dioxide laser

44.35

45885

Ligation of a facial, mandibular or lingual artery or vein, or artery and vein

457.55

45888

Removal of a deep foreign body using interventional imaging techniques

426.45

45891

Repair to one defect using temporalis muscle by a single stage local flap

621.30

45894

Free grafting of a granulating area (mucosa or split skin)

211.10

45897

Grafting of, including plastic closure of associated oronasal fistulae and ridge augmentation, a unilateral alveolar cleft (congenital)

1,102.50

45900

Fixation of the mandible by intermaxillary wiring, excluding wiring for obesity

248.65

45939

Cryosurgery of the peripheral branches of the trigeminal nerve for pain relief

461.05

45945

Treatment of a dislocation of the mandible requiring open reduction

122.40

45975

Treatment of a fracture of the unilateral or bilateral maxilla, not requiring splinting

133.20

45978

Treatment of a fracture of the mandible, not requiring splinting

162.80

45981

Treatment of the zygomatic bone, not requiring surgical reduction

88.30

45984

Treatment of a complicated fracture of the maxilla involving viscera, blood vessels or nerves, requiring open reduction not involving the use of a plate

635.90

45987

Treatment of a complicated fracture of the mandible involving viscera, blood vessels or nerves, requiring open reduction not involving the use of a plate

635.90

45990

Treatment of a complicated fracture of the maxilla including viscera, blood vessels or nerves, requiring open reduction involving the use of a plate

868.60

45993

Treatment of a complicated fracture of the mandible involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate

868.60

45996

Treatment of a closed fracture of the mandible involving a joint surface

246.25

 

Subdivision FSubgroup 14 of Group T8

5.10.24  Restriction on items 46300 to 46534—hand operations

  Items 46300 to 46534 apply only to a service provided in the course of an operation on a hand or hands.

5.10.25  Items in Subgroup 14 of Group T8

  This clause sets out items in Subgroup 14 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 14—Hand surgery

46300

Interphalangeal joint or metacarpophalangeal joint, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

348.95

46303

Carpometacarpal joint, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

387.85

46306

Interphalangeal joint or metacarpophalangeal joint—interposition arthroplasty of and including tendon transfers or realignment on the one ray (H) (Anaes.) (Assist.)

542.90

46307

Interphalangeal joint or metacarpophalangeal joint—volar plate arthroplasty for traumatic deformity including tendon transfers or realignment on the one ray (H) (Anaes.) (Assist.)

542.90

46309

Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—one joint (H) (Anaes.) (Assist.)

542.90

46312

Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—2 joints (H) (Anaes.) (Assist.)

698.10

46315

Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—3 joints (H) (Anaes.) (Assist.)

930.75

46318

Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—4 joints (H) (Anaes.) (Assist.)

1,163.50

46321

Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—5 or more joints (H) (Anaes.) (Assist.)

1,396.20

46324

Carpal bone replacement arthroplasty including associated tendon transfer or realignment when performed (H) (Anaes.) (Assist.)

832.55

46325

Carpal bone replacement or resection arthroplasty using adjacent tendon or other soft tissue including associated tendon transfer or realignment when performed (H) (Anaes.) (Assist.)

868.85

46327

Interphalangeal joint or metacarpophalangeal joint, arthrotomy of (Anaes.)

209.50

46330

Interphalangeal joint or metacarpophalangeal joint, ligamentous or capsular repair, with or without arthrotomy (H) (Anaes.) (Assist.)

356.90

46333

Interphalangeal joint or metacarpophalangeal joint, ligamentous repair of, using free tissue graft or implant (H) (Anaes.) (Assist.)

581.65

46336

Interphalangeal joint or metacarpophalangeal joint, synovectomy, capsulectomy or debridement of, other than a service associated with another procedure related to that joint (Anaes.) (Assist.)

271.50

46339

Extensor tendons or flexor tendons of hand or wrist, synovectomy of (Anaes.) (Assist.)

480.75

46342

Distal radioulnar joint or carpometacarpal joint or joints, synovectomy of (H) (Anaes.) (Assist.)

480.75

46345

Distal radioulnar joint, reconstruction or stabilisation of, including fusion, or ligamentous arthroplasty and excision of distal ulna, when performed (H) (Anaes.) (Assist.)

581.65

46348

Digit, synovectomy of flexor tendon or tendons—one digit (Anaes.)

252.10

46351

Digit, synovectomy of flexor tendon or tendons—2 digits (H) (Anaes.) (Assist.)

376.20

46354

Digit, synovectomy of flexor tendon or tendons—3 digits (H) (Anaes.) (Assist.)

504.10

46357

Digit, synovectomy of flexor tendon or tendons—4 digits (H) (Anaes.) (Assist.)

628.25

46360

Digit, synovectomy of flexor tendon or tendons—5 digits (H) (Anaes.) (Assist.)

756.30

46363

Tendon sheath of hand or wrist, open operation on, for stenosing tenovaginitis (Anaes.)

217.15

46366

Dupuytren’s contracture, subcutaneous fasciotomy for—each hand (Anaes.)

131.90

46369

Dupuytren’s contracture, palmar fasciectomy for—one hand (Anaes.)

217.15

46372

Dupuytren’s contracture, fasciectomy for, from one ray, including dissection of nerves—one hand (Anaes.) (Assist.)

441.30

46375

Dupuytren’s contracture, fasciectomy for, from 2 rays, including dissection of nerves—one hand (Anaes.) (Assist.)

523.55

46378

Dupuytren’s contracture, fasciectomy for, from 3 or more rays, including dissection of nerves—one hand (H) (Anaes.) (Assist.)

698.10

46381

Interphalangeal joint, joint capsule release when performed in conjunction with operation for Dupuytren’s contracture—each procedure (H) (Anaes.) (Assist.)

310.20

46384

Z plasty (or similar local flap procedure) when performed in conjunction with operation for Dupuytren’s contracture—one such procedure (H) (Anaes.) (Assist.)

310.20

46387

Dupuytren’s contracture, fasciectomy for, from one ray, including dissection of nerves—operation for recurrence in that ray (Anaes.) (Assist.)

640.00

46390

Dupuytren’s contracture, fasciectomy for, from 2 rays, including dissection of nerves—operation for recurrence in those rays (H) (Anaes.) (Assist.)

853.35

46393

Dupuytren’s contracture, fasciectomy for, from 3 or more rays, including dissection of nerves—operation for recurrence in those rays (H) (Anaes.) (Assist.)

988.95

46396

Phalanx or metacarpal of the hand, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (Anaes.) (Assist.)

339.85

46399

Phalanx or metacarpal of the hand, osteotomy of, with internal fixation (H) (Anaes.) (Assist.)

534.00

46402

Phalanx or metacarpal, bone grafting of, for pseudarthrosis (nonunion), including obtaining of graft material (H) (Anaes.) (Assist.)

534.00

46405

Phalanx or metacarpal, bone grafting of, for pseudarthrosis (nonunion), involving internal fixation and including obtaining of graft material (H) (Anaes.) (Assist.)

651.65

46408

Tendon, reconstruction of, by tendon graft (H) (Anaes.) (Assist.)

713.60

46411

Flexor tendon pulley, reconstruction of, by graft (H) (Anaes.) (Assist.)

418.85

46414

Artificial tendon prosthesis, insertion of, in preparation for tendon grafting (Anaes.) (Assist.)

542.80

46417

Tendon transfer for restoration of hand function, each transfer (H) (Anaes.) (Assist.)

504.10

46420

Extensor tendon of hand or wrist, primary repair of, each tendon (Anaes.)

210.95

46423

Extensor tendon of hand or wrist, secondary repair of, each tendon (Anaes.) (Assist.)

337.40

46426

Flexor tendon of hand or wrist, primary repair of, proximal to A1 pulley, each tendon (H) (Anaes.) (Assist.)

348.95

46429

Flexor tendon of hand or wrist, secondary repair of, proximal to A1 pulley, each tendon (Anaes.) (Assist.)

426.55

46432

Flexor tendon of hand, primary repair of, distal to A1 pulley, each tendon (H) (Anaes.) (Assist.)

465.45

46435

Flexor tendon of hand, secondary repair of, distal to A1 pulley, each tendon (H) (Anaes.) (Assist.)

542.90

46438

Mallet finger, closed pin fixation of (Anaes.)

139.65

46441

Mallet finger, open repair of, including pin fixation when performed (Anaes.) (Assist.)

337.40

46442

Mallet finger with intraarticular fracture involving more than onethird of base of terminal phalanx—open reduction (H) (Anaes.) (Assist.)

289.65

46444

Boutonniere deformity without joint contracture, reconstruction of (H) (Anaes.) (Assist.)

504.10

46447

Boutonniere deformity with joint contracture, reconstruction of (H) (Anaes.) (Assist.)

628.25

46450

Extensor tendon, tenolysis of, following tendon injury, repair or graft (H) (Anaes.)

232.75

46453

Flexor tendon, tenolysis of, following tendon injury, repair or graft (H) (Anaes.) (Assist.)

387.85

46456

Finger, percutaneous tenotomy of (Anaes.)

100.85

46459

Operation for osteomyelitis on distal phalanx (Anaes.)

193.90

46462

Operation for osteomyelitis on middle or proximal phalanx, metacarpal or carpus (Anaes.) (Assist.)

310.20

46464

Amputation of a supernumerary complete digit (Anaes.)

232.75

46465

Amputation of single digit, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.)

232.75

46468

Amputation of 2 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (H) (Anaes.) (Assist.)

407.20

46471

Amputation of 3 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.) (Assist.)

581.65

46474

Amputation of 4 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (H) (Anaes.) (Assist.)

756.30

46477

Amputation of 5 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (H) (Anaes.) (Assist.)

930.75

46480

Amputation of single digit, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover, including metacarpal (Anaes.) (Assist.)

387.85

46483

Revision of amputation stump to provide adequate soft tissue cover (Anaes.) (Assist.)

310.20

46486

Nail bed, accurate reconstruction of nail bed laceration using magnification, undertaken in the operating theatre of a hospital (H) (Anaes.)

232.75

46489

Nail bed, secondary exploration and accurate repair of nail bed deformity using magnification, undertaken in the operating theatre of a hospital (H) (Anaes.) (Assist.)

271.50

46492

Contracture of digits of hand, flexor or extensor, correction of, involving tissues deeper than skin and subcutaneous tissue (H) (Anaes.) (Assist.)

372.35

46494

Ganglion of hand, excision of, other than a service associated with a service to which another item in this Group applies (Anaes.)

226.80

46495

Ganglion or mucous cyst of distal digit, excision of, other than a service associated with a service to which item 30107 applies (Anaes.)

209.50

46498

Ganglion of flexor tendon sheath, excision of, other than a service associated with a service to which item 30107 applies (Anaes.)

226.80

46500

Ganglion of dorsal wrist joint, excision of, other than a service associated with a service to which item 30107 applies (Anaes.) (Assist.)

271.50

46501

Ganglion of volar wrist joint, excision of, other than a service associated with a service to which item 30107 applies (Anaes.) (Assist.)

339.45

46502

Recurrent ganglion of dorsal wrist joint, excision of, other than a service associated with a service to which item 30107 applies (Anaes.) (Assist.)

312.40

46503

Recurrent ganglion of volar wrist joint, excision of, other than a service associated with a service to which item 30107 applies (Anaes.) (Assist.)

390.20

46504

Neurovascular island flap, for pulp innervation (Anaes.) (Assist.)

1,140.10

46507

Digit or ray, transposition or transfer of, on vascular pedicle, complete procedure (H) (Anaes.) (Assist.)

1,326.40

46510

Macrodactyly, surgical reduction of enlarged elements—each digit (H) (Anaes.) (Assist.)

361.95

46513

Digital nail of finger or thumb, removal of, other than a service to which item 46516 applies (Anaes.)

58.25

46516

Digital nail of finger or thumb, removal of, in the operating theatre of a hospital (H) (Anaes.)

116.35

46519

Middle palmar, thenar or hypothenar spaces of hand, drainage of (excluding aftercare) (Anaes.)

145.65

46522

Flexor tendon sheath of finger or thumb—open operation and drainage for infection (H) (Anaes.) (Assist.)

434.35

46525

Pulp space infection, paronychia of hand, incision for, when performed in an operating theatre of a hospital, other than a service to which another item in this Group applies (excluding aftercare) (Anaes.)

58.25

46528

Ingrowing nail of finger or thumb, wedge resection for, including removal of segment of nail, ungual fold and portion of the nail bed (Anaes.)

174.80

46531

Ingrowing nail of finger or thumb, partial resection of nail, including phenolisation but not including excision of nail bed (Anaes.)

87.80

46534

Nail plate injury or deformity, radical excision of nail germinal matrix (Anaes.)

242.85

 

Subdivision GSubgroups 15, 16 and 17 of Group T8

5.10.26  Restriction on item 50303—timing

  A service described in item 50303 is applicable once in any 12 month period for each limb.

5.10.27  Restrictions on items 51011 to 51112 and 51115 to 51171—services provided in conjunction with other services in Group T8

  Items 51011 to 51112 and 51115 to 51171 do not apply to a service provided in conjunction with a service to which another item in Group T8 (other than an item in Subgroup 17) applies if the service in the other item is for the purpose of spinal surgery.

5.10.28  Restrictions on items 51061 to 51066—services provided in conjunction with certain other services

  Items 51061 to 51066 do not apply to a service provided in conjunction with a service to which any of items 51020 to 51045 apply.

5.10.29  Meaning of motion segment

  In this Schedule:

motion segment includes all anatomical structures (including traversing and exiting nerve roots) between, and including, the top of the pedicle above to the bottom of the pedicle below.

5.10.30  Items in Subgroups 15, 16 and 17 of Group T8

  This clause sets out items in Subgroups 15, 16 and 17 of Group T8.

 

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 15—Orthopaedic

47000

Mandible, treatment of dislocation of, by closed reduction (Anaes.)

72.90

47003

Clavicle, treatment of dislocation of, by closed reduction (Anaes.)

87.45

47006

Clavicle, treatment of dislocation of, by open reduction (Anaes.)

175.55

47009

Shoulder, treatment of dislocation of, requiring general anaesthesia, other than a service to which item 47012 applies (Anaes.)

174.80

47012

Shoulder, treatment of dislocation of, requiring general anaesthesia, open reduction (H) (Anaes.) (Assist.)

349.40

47015

Shoulder, treatment of dislocation of, not requiring general anaesthesia

87.45

47018

Elbow, treatment of dislocation of, by closed reduction (Anaes.)

203.75

47021

Elbow, treatment of dislocation of, by open reduction (H) (Anaes.) (Assist.)

271.80

47024

Radioulnar joint, distal or proximal, treatment of dislocation of, by closed reduction, other than a service associated with fracture or dislocation in the same region (Anaes.)

203.75

47027

Radioulnar joint, distal or proximal, treatment of dislocation of, by open reduction, other than a service associated with fracture or dislocation in the same region (H) (Anaes.) (Assist.)

271.80

47030

Carpus, or carpus on radius and ulna, or carpometacarpal joint, treatment of dislocation of, by closed reduction (Anaes.)

203.75

47033

Carpus, or carpus on radius and ulna, or carpometacarpal joint, treatment of dislocation of, by open reduction (Anaes.) (Assist.)

271.80

47036

Interphalangeal joint, treatment of dislocation of, by closed reduction (Anaes.)

87.45

47039

Interphalangeal joint, treatment of dislocation of, by open reduction (Anaes.)

116.35

47042

Metacarpophalangeal joint, treatment of dislocation of, by closed reduction (Anaes.)

116.35

47045

Metacarpophalangeal joint, treatment of dislocation of, by open reduction (Anaes.)

155.45

47048

Hip, treatment of dislocation of, by closed reduction (Anaes.)

334.95

47051

Hip, treatment of dislocation of, by open reduction (H) (Anaes.) (Assist.)

446.50

47054

Knee, treatment of dislocation of, by closed reduction (Anaes.) (Assist.)

334.95

47057

Patella, treatment of dislocation of, by closed reduction (Anaes.)

131.00

47060

Patella, treatment of dislocation of, by open reduction (Anaes.)

174.80

47063

Ankle or tarsus, treatment of dislocation of, by closed reduction (Anaes.)

262.10

47066

Ankle or tarsus, treatment of dislocation of, by open reduction (H) (Anaes.) (Assist.)

349.40

47069

Toe, treatment of dislocation of, by closed reduction (Anaes.)

72.90

47072

Toe, treatment of dislocation of, by open reduction (Anaes.)

96.95

47301

Phalanx, middle or proximal, treatment of fracture of, by closed reduction, requiring anaesthesia, not provided on the same occasion as a service described in item 47304, 47307, 47310, 47313, 47316 or 47319 (Anaes.)

89.50

47304

Metacarpal, treatment of fracture of, by closed reduction, requiring anaesthesia, not provided on the same occasion as a service described in item 47301, 47307, 47310, 47313, 47316 or 47319 (H) (Anaes.)

102.00

47307

Phalanx or metacarpal, treatment of fracture of, by closed reduction with percutaneous Kwire fixation (H) (Anaes.) (Assist.)

206.25

47310

Phalanx or metacarpal, treatment of fracture of, by open reduction with fixation (H) (Anaes.) (Assist.)

340.35

47313

Phalanx or metacarpal, treatment of intraarticular fracture of, by closed reduction with percutaneous Kwire fixation (H) (Anaes.) (Assist.)

330.00

47316

Phalanx or metacarpal, treatment of intraarticular fracture of, by open reduction with fixation, not provided on the same occasion as a service to which item 47319 applies (H) (Anaes.) (Assist.)

654.85

47319

Middle phalanx, proximal end, treatment of intraarticular fracture of, by open reduction with fixation, not provided on the same occasion as a service to which item 47316 applies (H) (Anaes.) (Assist.)

670.30

47348

Carpus (excluding scaphoid), treatment of fracture of, other than a service to which item 47351 applies (Anaes.)

96.95

47351

Carpus (excluding scaphoid), treatment of fracture of, by open reduction (Anaes.)

242.85

47354

Carpal scaphoid, treatment of fracture of, other than a service to which item 47357 applies (Anaes.)

174.80

47357

Carpal scaphoid, treatment of fracture of, by open reduction (Anaes.) (Assist.)

388.30

47361

Radius or ulna, or radius and ulna, distal end of, treatment of fracture of, by cast immobilisation, other than a service associated with a service to which item 47362, 47364, 47367, 47370 or 47373 applies

135.95

47362

Radius or ulna, or radius and ulna, distal end of, treatment of fracture of, by closed reduction, requiring general or major regional anaesthesia, but excluding local infiltration, other than a service associated with a service to which item 47361, 47364, 47367, 47370 or 47373 applies (Anaes.)

203.75

47364

Radius or ulna, distal end of, not involving joint surface, treatment of fracture of, by open reduction with fixation, other than a service associated with a service to which item 47361 or 47362 applies (H) (Anaes.) (Assist.)

288.75

47367

Radius, distal end of, treatment of fracture of, by closed reduction with percutaneous fixation, other than a service associated with a service to which item 47361 or 47362 applies (H) (Anaes.) (Assist.)

230.60

47370

Radius, distal end of, treatment of intraarticular fracture of, by open reduction with fixation, other than a service associated with a service to which item 47361 or 47362 applies (H) (Anaes.) (Assist.)

418.70

47373

Ulna, distal end of, treatment of intraarticular fracture of, by open reduction with fixation, other than a service associated with a service to which item 47361 or 47362 applies (H) (Anaes.) (Assist.)

299.05

47378

Radius or ulna, shaft of, treatment of fracture of, by cast immobilisation, other than a service to which item 47381, 47384, 47385 or 47386 applies (Anaes.)

174.80

47381

Radius or ulna, shaft of, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (H) (Anaes.)

262.10

47384

Radius or ulna, shaft of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

349.40

47385

Radius or ulna, shaft of, treatment of fracture of, in conjunction with dislocation of distal radioulnar joint or proximal radiohumeral joint (Galeazzi or Monteggia injury), by closed reduction undertaken in the operating theatre of a hospital (H) (Anaes.) (Assist.)

300.85

47386

Radius or ulna, shaft of, treatment of fracture of, in conjunction with dislocation of distal radioulnar joint or proximal radiohumeral joint (Galeazzi or Monteggia injury), by open reduction or internal fixation (H) (Anaes.) (Assist.)

485.40

47387

Radius and ulna, shafts of, treatment of fracture of, by cast immobilisation, other than a service to which item 47390 or 47393 applies (Anaes.) (Assist.)

281.45

47390

Radius and ulna, shafts of, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)

422.35

47393

Radius and ulna, shafts of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

563.05

47396

Olecranon, treatment of fracture of, other than a service to which item 47399 applies (Anaes.)

194.05

47399

Olecranon, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

388.30

47402

Olecranon, treatment of fracture of, involving excision of olecranon fragment and reimplantation of tendon (Anaes.) (Assist.)

291.15

47405

Radius, treatment of fracture of head or neck of, closed reduction of (Anaes.)

194.05

47408

Radius, treatment of fracture of head or neck of, open reduction of, including internal fixation and excision, if performed (H) (Anaes.) (Assist.)

388.30

47411

Humerus, treatment of fracture of tuberosity of, other than a service to which item 47417 applies (Anaes.)

116.35

47414

Humerus, treatment of fracture of tuberosity of, by open reduction (Anaes.)

233.05

47417

Humerus, treatment of fracture of tuberosity of, and associated dislocation of shoulder, by closed reduction (Anaes.) (Assist.)

271.80

47420

Humerus, treatment of fracture of tuberosity of, and associated dislocation of shoulder, by open reduction (H) (Anaes.) (Assist.)

534.00

47423

Humerus, proximal, treatment of fracture of, other than a service to which item 47426, 47429 or 47432 applies (Anaes.)

223.25

47426

Humerus, proximal, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)

334.95

47429

Humerus, proximal, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

446.50

47432

Humerus, proximal, treatment of intraarticular fracture of, by open reduction (H) (Anaes.) (Assist.)

558.20

47435

Humerus, proximal, treatment of fracture of, and associated dislocation of shoulder, by closed reduction (Anaes.) (Assist.)

427.20

47438

Humerus, proximal, treatment of fracture of, and associated dislocation of shoulder, by open reduction (H) (Anaes.) (Assist.)

679.75

47441

Humerus, proximal, treatment of intraarticular fracture of, and associated dislocation of shoulder, by open reduction (H) (Anaes.) (Assist.)

849.50

47444

Humerus, shaft of, treatment of fracture of, other than a service to which item 47447 or 47450 applies (Anaes.)

233.05

47447

Humerus, shaft of, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)

349.40

47450

Humerus, shaft of, treatment of fracture of, by internal or external (H) (Anaes.) (Assist.)

466.10

47451

Humerus, shaft of, treatment of fracture of, by intramedullary fixation (H) (Anaes.) (Assist.)

561.80

47453

Humerus, distal, (supracondylar or condylar), treatment of fracture of, other than a service to which item 47456 or 47459 applies (Anaes.) (Assist.)

271.80

47456

Humerus, distal (supracondylar or condylar), treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)

407.90

47459

Humerus, distal (supracondylar or condylar), treatment of fracture of, by open reduction, undertaken in the operating theatre of a hospital (H) (Anaes.) (Assist.)

543.75

47462

Clavicle, treatment of fracture of, other than a service to which item 47465 applies (Anaes.)

116.35

47465

Clavicle, treatment of fracture of, by open reduction (Anaes.) (Assist.)

233.05

47466

Sternum, treatment of fracture of, other than a service to which item 47467 applies (Anaes.)

116.35

47467

Sternum, treatment of fracture of, by open reduction (H) (Anaes.)

233.05

47468

Scapula, neck or glenoid region of, treatment of fracture of, by open reduction (Anaes.) (Assist.)

446.50

47471

Ribs (one or more), treatment of fracture of—each attendance

44.35

47474

Pelvic ring, treatment of fracture of, not involving disruption of pelvic ring or acetabulum

194.05

47477

Pelvic ring, treatment of fracture of, with disruption of pelvic ring or acetabulum

242.85

47480

Pelvic ring, treatment of fracture of, requiring traction (H) (Anaes.) (Assist.)

485.40

47483

Pelvic ring, treatment of fracture of, requiring control by external fixation (H) (Anaes.) (Assist.)

582.50

47486

Pelvic ring, treatment of fracture of, by open reduction and involving internal fixation of anterior segment, including diastasis of pubic symphysis (H) (Anaes.) (Assist.)

970.85

47489

Pelvic ring, treatment of fracture of, by open reduction and involving internal fixation of posterior segment (including sacroiliac joint), with or without fixation of anterior segment (H) (Anaes.) (Assist.)

1,456.30

47492

Acetabulum, treatment of fracture of, and associated dislocation of hip (Anaes.)

242.85

47495

Acetabulum, treatment of fracture of, and associated dislocation of hip, requiring traction (Anaes.) (Assist.)

485.40

47498

Acetabulum, treatment of fracture of, and associated dislocation of hip, requiring internal fixation, with or without traction (H) (Anaes.) (Assist.)

728.10

47501

Acetabulum, treatment of single column fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

970.85

47504

Acetabulum, treatment of Tshape fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, excluding services to which item 47933 or 47936 applies (Anaes.) (Assist.)

1,456.30

47507

Acetabulum, treatment of transverse fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,456.30

47510

Acetabulum, treatment of double column fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

1,456.30

47513

Sacroiliac joint disruption, treatment of, requiring internal fixation, being a service associated with a service to which items 47501 to 47510 apply (H) (Anaes.) (Assist.)

388.30

47516

Femur, treatment of fracture of, by closed reduction or traction (Anaes.) (Assist.)

446.50

47519

Femur, treatment of trochanteric or subcapital fracture of, by internal fixation (H) (Anaes.) (Assist.)

893.25

47522

Femur, treatment of subcapital fracture of, by hemiarthroplasty (H) (Anaes.) (Assist.)

776.80

47525

Femur, treatment of fracture of, for slipped capital femoral epiphysis (H) (Anaes.) (Assist.)

893.25

47528

Femur, treatment of fracture of, by internal fixation or external fixation (H) (Anaes.) (Assist.)

776.80

47531

Femur, treatment of fracture of shaft, by intramedullary fixation and cross fixation (H) (Anaes.) (Assist.)

990.25

47534

Femur, condylar region of, treatment of intraarticular (Tshaped condylar) fracture of, requiring internal fixation, with or without internal fixation of one or more osteochondral fragments (H) (Anaes.) (Assist.)

1,116.50

47537

Femur, condylar region of, treatment of fracture of, requiring internal fixation of one or more osteochondral fragments, other than a service associated with a service to which item 47534 applies (Anaes.) (Assist.)

446.50

47540

Hip spica or shoulder spica, application of, as an independent procedure (Anaes.)

223.25

47543

Tibia, plateau of, treatment of medial or lateral fracture of, other than a service to which item 47546 or 47549 applies (Anaes.)

233.05

47546

Tibia, plateau of, treatment of medial or lateral fracture of, by closed reduction (Anaes.)

349.40

47549

Tibia, plateau of, treatment of medial or lateral fracture of, by open reduction (H) (Anaes.) (Assist.)

466.10

47552

Tibia, plateau of, treatment of both medial and lateral fractures of, other than a service to which item 47555 or 47558 applies (Anaes.) (Assist.)

388.30

47555

Tibia, plateau of, treatment of both medial and lateral fractures of, by closed reduction (H) (Anaes.)

582.50

47558

Tibia, plateau of, treatment of both medial and lateral fractures of, by open reduction (H) (Anaes.) (Assist.)

776.80

47561

Tibia, shaft of, treatment of fracture of, by cast immobilisation, other than a service to which item 47564, 47567, 47570 or 47573 applies (Anaes.)

281.45

47564

Tibia, shaft of, treatment of fracture of, by closed reduction, with or without treatment of fibular fracture (Anaes.)

422.35

47565

Tibia, shaft of, treatment of fracture of, by internal fixation or external fixation (H) (Anaes.) (Assist.)

734.65

47566

Tibia, shaft of, treatment of fracture of, by intramedullary fixation and cross fixation (H) (Anaes.) (Assist.)

936.45

47567

Tibia, shaft of, treatment of intraarticular fracture of, by closed reduction, with or without treatment of fibular fracture (Anaes.) (Assist.)

490.20

47570

Tibia, shaft of, treatment of fracture of, by open reduction, with or without treatment of fibular fracture (Anaes.) (Assist.)

563.05

47573

Tibia, shaft of, treatment of intraarticular fracture of, by open reduction, with or without treatment of fibular fracture (H) (Anaes.) (Assist.)

703.85

47576

Fibula, treatment of fracture of (Anaes.)

116.35

47579

Patella, treatment of fracture of, other than a service to which item 47582 or 47585 applies (Anaes.)

165.05

47582

Patella, treatment of fracture of, by excision of patella or pole with reattachment of tendon (H) (Anaes.) (Assist.)

339.85

47585

Patella, treatment of fracture of, by internal fixation (H) (Anaes.) (Assist.)

437.00

47588

Knee joint, treatment of fracture of, by internal fixation of intraarticular fractures of femoral condylar or tibial articular surfaces and requiring repair or reconstruction of one or more ligaments (H) (Anaes.) (Assist.)

1,359.00

47591

Knee joint, treatment of fracture of, by internal fixation of intraarticular fractures of femoral condylar and tibial articular surfaces and requiring repair or reconstruction of one or more ligaments (H) (Anaes.) (Assist.)

1,650.65

47594

Ankle joint, treatment of fracture of, other than a service to which item 47597 applies (Anaes.)

223.25

47597

Ankle joint, treatment of fracture of, by closed reduction (Anaes.)

334.95

47600

Ankle joint, treatment of fracture of, by internal fixation of one of malleolus, fibula or diastasis (H) (Anaes.) (Assist.)

446.50

47603

Ankle joint, treatment of fracture of, by internal fixation of more than one of malleolus, fibula or diastasis (H) (Anaes.) (Assist.)

582.50

47606

Calcaneum or talus, treatment of fracture of, other than a service to which item 47609, 47612, 47615 or 47618 applies, with or without dislocation (Anaes.)

242.85

47609

Calcaneum or talus, treatment of fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)

364.10

47612

Calcaneum or talus, treatment of intraarticular fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)

422.35

47615

Calcaneum or talus, treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)

485.40

47618

Calcaneum or talus, treatment of intraarticular fracture of, by open reduction, with or without dislocation (H) (Anaes.) (Assist.)

606.80

47621

Tarsometatarsal, treatment of intraarticular fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)

422.35

47624

Tarsometatarsal, treatment of fracture of, by open reduction, with or without dislocation (H) (Anaes.) (Assist.)

582.50

47627

Tarsus (excluding calcaneum or talus), treatment of fracture of (Anaes.)

165.05

47630

Tarsus (excluding calcaneum or talus), treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)

349.40

47633

Metatarsal, one of, treatment of fracture of (Anaes.)

116.35

47636

Metatarsal, one of, treatment of fracture of, by closed reduction (Anaes.)

174.80

47639

Metatarsal, one of, treatment of fracture of, by open reduction (Anaes.)

233.05

47642

Metatarsals, 2 of, treatment of fracture of (Anaes.)

155.45

47645

Metatarsals, 2 of, treatment of fracture of, by closed reduction (Anaes.)

233.05

47648

Metatarsals, 2 of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

310.45

47651

Metatarsals, 3 or more of, treatment of fracture of (Anaes.)

242.85

47654

Metatarsals, 3 or more of, treatment of fracture of, by closed reduction (Anaes.) (Assist.)

364.10

47657

Metatarsals, 3 or more of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

485.40

47663

Phalanx of great toe, treatment of fracture of, by closed reduction (Anaes.)

145.65

47666

Phalanx of great toe, treatment of fracture of, by open reduction (Anaes.)

242.85

47672

Phalanx of toe (other than great toe), one of, treatment of fracture of, by open reduction (Anaes.)

116.35

47678

Phalanx of toe (other than great toe), more than one of, treatment of fracture of, by open reduction (Anaes.)

174.80

47726

Bone graft, harvesting of, via separate incision, in conjunction with another service, autogenous, small quantity (H) (Anaes.)

145.65

47729

Bone graft, harvesting of, via separate incision, in conjunction with another service, autogenous, large quantity (H) (Anaes.)

242.85

47732

Vascularised pedicle bone graft, harvesting of, in conjunction with another service (H) (Anaes.) (Assist.)

388.30

47735

Nasal bones, treatment of fracture of, other than a service to which item 47738 or 47741 applies—each attendance

44.40

47738

Nasal bones, treatment of fracture of, by reduction (Anaes.)

242.85

47741

Nasal bones, treatment of fracture of, by open reduction involving osteotomies (H) (Anaes.) (Assist.)

495.35

47753

Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (H) (Anaes.) (Assist.)

419.35

47756

Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (H) (Anaes.) (Assist.)

419.35

47762

Zygomatic bone, treatment of fracture of, requiring surgical reduction by a temporal, intraoral or other approach (Anaes.)

246.25

47765

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at one site (H) (Anaes.) (Assist.)

404.35

47768

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (H) (Anaes.) (Assist.)

495.35

47771

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (H) (Anaes.) (Assist.)

569.10

47774

Maxilla, treatment of fracture of, requiring open operation (H) (Anaes.) (Assist.)

449.25

47777

Mandible, treatment of fracture of, requiring open reduction (H) (Anaes.) (Assist.)

449.25

47780

Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (H) (Anaes.) (Assist.)

584.05

47783

Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)

584.05

47786

Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (H) (Anaes.) (Assist.)

741.20

47789

Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (H) (Anaes.) (Assist.)

741.20

47900

Bone cyst, injection into or aspiration of (Anaes.)

174.80

47903

Epicondylitis, open operation for (Anaes.)

242.85

47904

Digital nail of toe, removal of, other than a service to which item 47906 applies (Anaes.)

58.25

47906

Digital nail of toe, removal of, in the operating theatre of a hospital (H) (Anaes.)

116.35

47912

Pulp space infection, paronychia of foot, incision for, other than a service to which another item in this Group applies (excluding aftercare) (Anaes.)

58.25

47915

Ingrowing nail of toe, wedge resection for, with removal of segment of nail, ungual fold and portion of the nail bed (Anaes.)

174.80

47916

Ingrowing nail of toe, partial resection of nail, with destruction of nail matrix by phenolisation, electrocautery, laser, sodium hydroxide or acid but not including excision of nail bed (Anaes.)

87.80

47918

Ingrowing toenail, radical excision of nailbed (Anaes.)

242.85

47920

Bone growth stimulator, insertion of (H) (Anaes.) (Assist.)

392.70

47921

Orthopaedic pin or wire, insertion of, as an independent procedure (Anaes.)

116.35

47924

Buried wire, pin or screw, one or more of, which were inserted for internal fixation purposes, removal of requiring incision and suture, other than a service to which item 47927 or 47930 applies—per bone (Anaes.)

38.80

47927

Buried wire, pin or screw, one or more of, which were inserted for internal fixation purposes, removal of, in the operating theatre of a hospital—per bone (H) (Anaes.)

145.65

47930

Plate, rod or nail and associated wires, pins or screws, one or more of, all of which were inserted for internal fixation purposes, removal of, other than a service associated with a service to which item 47924 or 47927 applies—per bone (H) (Anaes.) (Assist.)

271.80

47933

Small exostosis (not more than 20 mm of growth above bone), excision of, or simple removal of bunion and any associated bursa, other than a service associated with a service for removal of bursa (Anaes.)

213.45

47936

Large exostosis (greater than 20 mm growth above bone), excision of (H) (Anaes.) (Assist.)

262.10

47948

External fixation, removal of, in the operating theatre of a hospital (H) (Anaes.)

165.05

47951

External fixation, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)

194.05

47954

Tendon, repair of, as an independent procedure (Anaes.) (Assist.)

388.30

47957

Tendon, large, lengthening of, as an independent procedure (H) (Anaes.) (Assist.)

291.15

47960

Tenotomy, subcutaneous, other than a service to which another item in this Group applies (Anaes.)

135.95

47963

Tenotomy, open, with or without tenoplasty, other than a service to which another item in this Group applies (Anaes.)

223.25

47966

Tendon or ligament transfer, as an independent procedure (H) (Anaes.) (Assist.)

446.50

47969

Tenosynovectomy, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

271.80

47972

Tendon sheath, open operation for tenovaginitis, other than a service to which another item in this Group applies (H) (Anaes.)

217.15

47975

Forearm or calf, decompression fasciotomy of, for acute compartment syndrome, requiring excision of muscle and deep tissue (H) (Anaes.) (Assist.)

380.70

47978

Forearm or calf, decompression fasciotomy of, for chronic compartment syndrome, requiring excision of muscle and deep tissue (H) (Anaes.)

231.20

47981

Forearm, calf or interosseous muscle space of hand, decompression fasciotomy of, other than a service to which another item in this Group applies (Anaes.)

155.25

47982

Forage (Drill decompression), of neck or head of femur, or both (H) (Anaes.) (Assist.)

376.30

48200

Femur, bone graft to (H) (Anaes.) (Assist.)

776.80

48203

Femur, bone graft to, with internal fixation (H) (Anaes.) (Assist.)

941.75

48206

Tibia, bone graft to (H) (Anaes.) (Assist.)

583.10

48209

Tibia, bone graft to, with internal fixation (H) (Anaes.) (Assist.)

747.60

48212

Humerus, bone graft to (H) (Anaes.) (Assist.)

583.10

48215

Humerus, bone graft to, with internal fixation (H) (Anaes.) (Assist.)

747.60

48218

Radius or ulna, bone graft to (H) (Anaes.) (Assist.)

583.10

48221

Radius and ulna, bone graft to, with internal fixation of one or both bones (H) (Anaes.) (Assist.)

776.80

48224

Radius or ulna, bone graft to (H) (Anaes.) (Assist.)

388.30

48227

Radius or ulna, bone graft to, with internal fixation of one or both bones (H) (Anaes.) (Assist.)

504.85

48230

Scaphoid, bone graft to, for nonunion (H) (Anaes.) (Assist.)

437.00

48233

Scaphoid, bone graft to, for nonunion, with internal fixation (H) (Anaes.) (Assist.)

631.05

48236

Scaphoid, bone graft to, for malunion, including osteotomy, bone graft and internal fixation (H) (Anaes.) (Assist.)

825.20

48239

Bone graft, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

456.30

48242

Bone graft, with internal fixation, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

631.05

48400

Phalanx, metatarsal, accessory bone or sesamoid bone, osteotomy or osteectomy of, excluding services to which item 49848 or 49851 applies, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

339.85

48403

Phalanx or metatarsal, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

534.00

48406

Fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

339.85

48409

Fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, osteotomy or osteectomy, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

534.00

48412

Humerus, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

650.35

48415

Humerus, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

825.20

48418

Tibia, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

650.35

48421

Tibia, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

825.20

48424

Femur or pelvis, osteotomy or osteectomy of, other than a service:

(a) associated with surgery for femoroacetabular impingement; or

(b) to which item 47933 or 47936 applies

(H) (Anaes.) (Assist.)

776.80

48427

Femur or pelvis, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)

941.75

48500

Femur, epiphysiodesis of (H) (Anaes.) (Assist.)

339.85

48503

Tibia and fibula, epiphysiodesis of (H) (Anaes.) (Assist.)

339.85

48506

Femur, tibia and fibula, epiphysiodesis of (H) (Anaes.) (Assist.)

504.85

48509

Epiphysiodesis, staple arrest of hemiepiphysis (H) (Anaes.)

242.85

48512

Epiphysiolysis, operation to prevent closure of plate (H) (Anaes.) (Assist.)

922.35

48900

Shoulder, excision of coracoacromial ligament or removal of calcium deposit from cuff or both (Anaes.) (Assist.)

291.15

48903

Shoulder, decompression of subacromial space by acromioplasty, excision of coracoacromial ligament and distal clavicle, or any combination (H) (Anaes.) (Assist.)

582.50

48906

Shoulder, repair of rotator cuff, including excision of coracoacromial ligament or removal of calcium deposit from cuff, or both—other than a service associated with a service to which item 48900 applies (H) (Anaes.) (Assist.)

582.50

48909

Shoulder, repair of rotator cuff, including decompression of subacromial space by acromioplasty, excision of coracoacromial ligament and distal clavicle, or any combination, other than a service associated with a service to which item 48903 applies (H) (Anaes.) (Assist.)

776.80

48912

Shoulder, arthrotomy of (Anaes.) (Assist.)

339.85

48915

Shoulder, hemiarthroplasty of (H) (Anaes.) (Assist.)

776.80

48918

Shoulder, total replacement arthroplasty of, including any associated rotator cuff repair (H) (Anaes.) (Assist.)

1,553.50

48921

Shoulder, total replacement arthroplasty, revision of (H) (Anaes.) (Assist.)

1,601.90

48924

Shoulder, total replacement arthroplasty, revision of, requiring bone graft to scapula or humerus, or both (H) (Anaes.) (Assist.)

1,844.70

48927

Shoulder prosthesis, removal of (H) (Anaes.) (Assist.)

378.50

48930

Shoulder, stabilisation procedure for recurrent anterior or posterior dislocation (H) (Anaes.) (Assist.)

776.80

48933

Shoulder, stabilisation procedure for multidirectional instability, anterior or posterior (or both) repair when performed (H) (Anaes.) (Assist.)

1,019.40

48936

Shoulder, synovectomy of, as an independent procedure (H) (Anaes.) (Assist.)

776.80

48939

Shoulder, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

1,116.50

48942

Shoulder, arthrodesis of, with synovectomy if performed, with removal of prosthesis, requiring bone grafting or internal fixation (H) (Anaes.) (Assist.)

1,456.30

48945

Shoulder, diagnostic arthroscopy of (including biopsy)—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)

281.45

48948

Shoulder, arthroscopic surgery of, involving any one or more of: removal of loose bodies; decompression of calcium deposit; debridement of labrum, synovium or rotator cuff; or chondroplasty—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)

631.05

48951

Shoulder, arthroscopic division of coracoacromial ligament including acromioplasty—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)

922.35

48954

Shoulder, arthroscopic total synovectomy of, including release of contracture when performed—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)

970.85

48957

Shoulder, arthroscopic stabilisation of, for recurrent instability including labral repair or reattachment when performed—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)

1,116.50

48960

Shoulder, reconstruction or repair of, including repair of rotator cuff by arthroscopic, arthroscopic assisted or mini open means; arthroscopic acromioplasty; or resection of acromioclavicular joint by separate approach when performed—other than a service associated with another procedure of the shoulder region (H) (Anaes.) (Assist.)

970.85

49100

Elbow, arthrotomy of, involving one or more of lavage, removal of loose body or division of contracture (H) (Anaes.) (Assist.)

339.85

49103

Elbow, ligamentous stabilisation of (H) (Anaes.) (Assist.)

728.10

49106

Elbow, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)

970.85

49109

Elbow, total synovectomy of (H) (Anaes.) (Assist.)

728.10

49112

Elbow, silastic or other replacement of radial head (H) (Anaes.) (Assist.)

728.10

49115

Elbow, total joint replacement of (H) (Anaes.) (Assist.)

1,164.90

49116

Elbow, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)

1,537.70

49117

Elbow, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (H) (Anaes.) (Assist.)

1,845.25

49118

Elbow, diagnostic arthroscopy of, including biopsy and lavage, other than a service associated with another arthroscopic procedure of the elbow (H) (Anaes.) (Assist.)

281.45

49121

Elbow, arthroscopic surgery involving any one or more of the following:

(a) drilling of defect;

(b) removal of loose body;

(c) release of contracture or adhesions;

(d) chondroplasty;

(e) osteoplasty;

other than a service associated with another arthroscopic procedure of the elbow (H) (Anaes.) (Assist.)

631.05

49200

Wrist, arthrodesis of, with synovectomy if performed, with or without bone graft and internal fixation of the radiocarpal joint (H) (Anaes.) (Assist.)

844.55

49203

Wrist, limited arthrodesis of the intercarpal joint, with synovectomy if performed, with or without bone graft (H) (Anaes.) (Assist.)

631.05

49206

Wrist, proximal carpectomy of, including styloidectomy when performed (H) (Anaes.) (Assist.)

582.50

49209

Wrist, total replacement arthroplasty of (H) (Anaes.) (Assist.)

776.80

49210

Wrist, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)

1,025.35

49211

Wrist, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (H) (Anaes.) (Assist.)

1,230.45

49212

Wrist, arthrotomy of (H) (Anaes.)

242.85

49215

Wrist, reconstruction of, including repair of single or multiple ligaments or capsules, including associated arthrotomy (H) (Anaes.) (Assist.)

670.00

49218

Wrist, diagnostic arthroscopy of, including radiocarpal or midcarpal joints, or both (including biopsy)—other than a service associated with another arthroscopic procedure of the wrist joint (H) (Anaes.) (Assist.)

281.45

49221

Wrist, arthroscopic surgery of, involving any one or more of the following:

(a) drilling of defect;

(b) removal of loose body;

(c) release of adhesions;

(d) local synovectomy;

(e) debridement of one area;

other than a service associated with another arthroscopic procedure of the wrist joint (H) (Anaes.) (Assist.)

631.05

49224

Wrist, arthroscopic debridement of: 2 or more distinct areas; or osteoplasty including excision of the distal ulna; or total synovectomy, other than a service associated with another arthroscopic procedure of the wrist (H) (Anaes.) (Assist.)

728.10

49227

Wrist, arthroscopic pinning of osteochondral fragment or stabilisation procedure for ligamentous disruption—other than a service associated with another arthroscopic procedure of the wrist joint (H) (Anaes.) (Assist.)

728.10

49300

Sacroiliac joint—arthrodesis of (H) (Anaes.) (Assist.)

537.55

49303

Hip, arthrotomy of, including lavage, drainage or biopsy when performed, other than a service associated with surgery for femoroacetabular impingement (H) (Anaes.) (Assist.)

563.05

49306

Hiparthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

1,116.50

49309

Hip, arthrectomy or excision arthroplasty of, including removal of prosthesis (Austin Moore or similar (non cement)) (H) (Anaes.) (Assist.)

776.80

49312

Hip, arthrectomy or excision arthroplasty of, including removal of prosthesis (cemented, porous coated or similar) (H) (Anaes.) (Assist.)

970.85

49315

Hip, arthroplasty of, unipolar or bipolar (H) (Anaes.) (Assist.)

873.80

49318

Hip, total replacement arthroplasty of, including minor bone grafting (H) (Anaes.) (Assist.)

1,359.00

49319

Hip, total replacement arthroplasty of, including associated minor grafting, if performed—bilateral (H) (Anaes.) (Assist.)

2,387.65

49321

Hip, total replacement arthroplasty of, including major bone grafting, including obtaining of graft (H) (Anaes.) (Assist.)

1,650.65

49324

Hip, total replacement arthroplasty of, revision procedure including removal of prosthesis (H) (Anaes.) (Assist.)

1,941.80

49327

Hip, total replacement arthroplasty of, revision procedure requiring bone grafting to acetabulum, including obtaining of graft (H) (Anaes.) (Assist.)

2,233.00

49330

Hip, total replacement arthroplasty of, revision procedure requiring bone grafting to femur, including obtaining of graft (H) (Anaes.) (Assist.)

2,233.00

49333

Hip, total replacement arthroplasty of, revision procedure requiring bone grafting to both acetabulum and femur, including obtaining of graft (H) (Anaes.) (Assist.)

2,524.30

49336

Hip, treatment of a fracture of the femur if revision total hip replacement is required as part of the treatment of the fracture (not including intraoperative fracture), being a service associated with a service to which items 49324 to 49333 apply (H) (Anaes.) (Assist.)

368.85

49339

Hip, revision total replacement of, requiring anatomic specific allograft of proximal femur greater than 5 cm in length (H) (Anaes.) (Assist.)

2,864.10

49342

Hip, revision total replacement of, requiring anatomic specific allograft of acetabulum (H) (Anaes.) (Assist.)

2,864.10

49345

Hip, revision total replacement of, requiring anatomic specific allograft of both femur and acetabulum (H) (Anaes.) (Assist.)

3,398.00

49346

Hip, revision arthroplasty with replacement of acetabular liner or ceramic head, not requiring removal of femoral component or acetabular shell (H) (Anaes.) (Assist.)

873.80

49360

Hip, diagnostic arthroscopy of, other than a service associated with another arthroscopic procedure of the hip (H) (Anaes.) (Assist.)

354.70

49363

Hip, diagnostic arthroscopy of, with synovial biopsy, other than a service associated with another arthroscopic procedure of the hip (H) (Anaes.) (Assist.)

427.15

49366

Hip, arthroscopic surgery of, other than a service associated with:

(a) another arthroscopic procedure of the hip; or

(b) surgery for femoroacetabular impingement

(H) (Anaes.) (Assist.)

631.05

49500

Knee, arthrotomy of, involving one or more of capsular release, biopsy or lavage, or removal of loose body or foreign body (H) (Anaes.) (Assist.)

388.30

49503

Knee, partial or total meniscectomy of, repair of collateral or cruciate ligament, patellectomy of, chondroplasty of, osteoplasty of, patellofemoral stabilisation or single transfer of ligament or tendon (other than a service to which another item in this Group applies)—any one procedure (H) (Anaes.) (Assist.)

504.85

49506

Knee, partial or total meniscectomy of, repair of collateral or cruciate ligament, patellectomy of, chondroplasty of, osteoplasty of, patellofemoral stabilisation or single transfer of ligament or tendon (other than a service to which another item in this Group applies)—any 2 or more procedures (H) (Anaes.) (Assist.)

757.35

49509

Knee, total synovectomy or arthrodesis with synovectomy if performed (H) (Anaes.) (Assist.)

776.80

49512

Knee, arthrodesis of, with synovectomy if performed, with removal of prosthesis (H) (Anaes.) (Assist.)

1,116.50

49515

Knee, removal of prosthesis, cemented or uncemented, including associated cement, as the first stage of a 2 stage procedure (H) (Anaes.) (Assist.)

873.80

49517

Knee, hemiarthroplasty of (H) (Anaes.) (Assist.)

1,244.05

49518

Knee, total replacement arthroplasty of (H) (Anaes.) (Assist.)

1,359.00

49519

Knee, total replacement arthroplasty of, including associated minor grafting, if performed—bilateral (H) (Anaes.) (Assist.)

2,387.65

49521

Knee, total replacement arthroplasty of, requiring major bone grafting to femur or tibia, including obtaining of graft (H) (Anaes.) (Assist.)

1,650.65

49524

Knee, total replacement arthroplasty of, requiring major bone grafting to femur and tibia, including obtaining of graft (H) (Anaes.) (Assist.)

1,941.80

49527

Knee, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)

1,650.65

49530

Knee, total replacement arthroplasty of, revision procedure, requiring bone grafting to femur or tibia, including obtaining of graft and including removal of prosthesis (H) (Anaes.) (Assist.)

2,039.00

49533

Knee, total replacement arthroplasty of, revision procedure, requiring bone grafting to both femur and tibia, including obtaining of graft and including removal of prosthesis (H) (Anaes.) (Assist.)

2,330.25

49534

Knee, patellofemoral joint of, total replacement arthroplasty as a primary procedure (H) (Anaes.) (Assist.)

463.60

49536

Knee, repair or reconstruction of, for chronic instability (open or arthroscopic, or both) involving either cruciate or collateral ligaments, including notchplasty when performed, other than a service associated with another arthroscopic procedure of the knee (H) (Anaes.) (Assist.)

970.85

49539

Knee, reconstructive surgery of cruciate ligament or ligaments (open or arthroscopic, or both), including notchplasty when performed and surgery to other internal derangements, other than a service to which another item in this Group applies or a service associated with another arthroscopic procedure of the knee (H) (Anaes.) (Assist.)

970.85

49542

Knee, reconstructive surgery of cruciate ligament or ligaments (open or arthroscopic, or both), including notchplasty, meniscus repair, extracapsular procedure and debridement when performed, other than a service associated with another arthroscopic procedure of the knee (H) (Anaes.) (Assist.)

1,359.00

49545

Knee, revision arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

776.80

49548

Knee, revision of patellofemoral stabilisation (H) (Anaes.) (Assist.)

970.85

49551

Knee, revision of procedures to which item 49536, 49539 or 49542 applies (H) (Anaes.) (Assist.)

1,359.00

49554

Knee, revision of total replacement of, by anatomic specific allograft of tibia or femur (H) (Anaes.) (Assist.)

1,941.80

49557

Knee, diagnostic arthroscopy of (including biopsy, simple trimming of meniscal margin or plica)—other than a service associated with:

(a) autologous chondrocyte implantation; or

(b) matrixinduced autologous chondrocyte implantation; or

(c) another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

281.45

49558

Knee, arthroscopic surgery of, involving one or more of debridement, osteoplasty or chrondroplasty—not associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

281.45

49559

Knee, arthroscopic surgery of, involving chrondroplasty requiring multiple drilling or carbon fibre (or similar) implant, including any associated debridement or osteoplasty—not associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

421.50

49560

Knee, arthroscopic surgery of, involving one or more of partial or total meniscectomy, removal of loose body or lateral release—other than a service associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

568.85

49561

Knee, arthroscopic surgery of, involving one or more of partial or total meniscectomy, removal of loose body or lateral release, if the procedure includes associated debridement, osteoplasty or chrondroplasty—not associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

695.05

49562

Knee, arthroscopic surgery of, involving one or more of partial or total meniscectomy, removal of loose body or lateral release, if the procedure includes chondroplasty requiring multiple drilling or carbon fibre (or similar) implant and associated debridement or osteoplasty—not associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

758.45

49563

Knee, arthroscopic surgery of, involving one or more of the following:

(a) meniscus repair;

(b) osteochondral graft;

(c) chondral graft;

excluding autologous chondrocyte implantation or matrixinduced autologous chondrocyte implantation and not associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)

821.60

49564

Knee, patellofemoral stabilisation of, combined arthroscopic and open procedure, including lateral release, medial capsulorrhaphy and tendon transfer, other than a service associated with another arthroscopic procedure of the knee (H) (Anaes.) (Assist.)

947.75

49566

Knee, arthroscopic total synovectomy of, other than a service associated with another arthroscopic procedure of the knee (H) (Anaes.) (Assist.)

776.80

49569

Knee, mobilisation for posttraumatic stiffness, by multiple muscle or tendon release (quadricepsplasty) (H) (Anaes.) (Assist.)

776.80

49700

Ankle, diagnostic arthroscopy of, including biopsy (H) (Anaes.) (Assist.)

281.45

49703

Ankle, arthroscopic surgery of (H) (Anaes.) (Assist.)

631.05

49706

Ankle, arthrotomy of, involving one or more of lavage, removal of loose body or division of contracture (H) (Anaes.) (Assist.)

339.85

49709

Ankle, ligamentous stabilisation of (H) (Anaes.) (Assist.)

728.10

49712

Ankle, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

776.80

49715

Ankle, total joint replacement of (H) (Anaes.) (Assist.)

1,164.90

49716

Ankle, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)

1,537.70

49717

Ankle, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (H) (Anaes.) (Assist.)

1,845.25

49718

Ankle, Achilles’ tendon or other major tendon, repair of (H) (Anaes.) (Assist.)

388.30

49721

Ankle, Achilles’ tendon rupture managed by nonoperative treatment

242.85

49724

Ankle, Achilles’ tendon, secondary repair or reconstruction of (H) (Anaes.) (Assist.)

679.75

49727

Ankle, Achilles’ tendon, operation for lengthening (H) (Anaes.) (Assist.)

291.15

49728

Ankle, lengthening of the gastrocnemius aponeurosis and soleus fascia, for the correction of equinus deformity in children with cerebral palsy (H) (Anaes.) (Assist.)

582.35

49800

Foot, flexor or extensor tendon, primary repair of (Anaes.)

135.95

49803

Foot, flexor or extensor tendon, secondary repair of (Anaes.)

174.80

49806

Foot, subcutaneous tenotomy of, one or more tendons (Anaes.)

135.95

49809

Foot, open tenotomy of, with or without tenoplasty (H) (Anaes.)

223.25

49812

Foot, tendon or ligament transplantation of, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

446.50

49815

Foot, triple arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

776.80

49818

Foot, excision of calcaneal spur (H) (Anaes.) (Assist.)

281.45

49821

Foot, correction of hallux valgus or hallux rigidus by excision arthroplasty (Keller’s or similar procedure)—unilateral (H) (Anaes.) (Assist.)

446.50

49824

Foot, correction of hallux valgus or hallux rigidus by excision arthroplasty (Keller’s or similar procedure)—bilateral (H) (Anaes.) (Assist.)

781.65

49827

Foot, correction of hallux valgus by transfer of adductor hallucis tendon—unilateral (H) (Anaes.) (Assist.)

485.40

49830

Foot, correction of hallux valgus by transfer of adductor hallucis tendon—bilateral (H) (Anaes.) (Assist.)

849.50

49833

Foot, correction of hallus valgus by osteotomy of first metatarsal with or without internal fixation and with or without excision of exostoses associated with the first metatarsophalangeal joint—unilateral (H) (Anaes.) (Assist.)

534.00

49836

Foot, correction of hallus valgus by osteotomy of first metatarsal with or without internal fixation and with or without excision of exostoses associated with the first metatarsophalangeal joint—bilateral (H) (Anaes.) (Assist.)

922.35

49837

Foot, correction of hallus valgus by osteotomy of first metatarsal and transfer of adductor hallicus tendon, with or without internal fixation and with or without excision of exostoses associated with the first metatarsal joint—unilateral (H) (Anaes.) (Assist.)

667.45

49838

Foot, correction of hallus valgus by osteotomy of first metatarsal and transfer of adductor hallicus tendon, with or without internal fixation and with or without excision of exostoses associated with the first metatarsal joint—bilateral (H) (Anaes.) (Assist.)

1,152.70

49839

Foot, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty—unilateral (H) (Anaes.) (Assist.)

534.00

49842

Foot, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty—bilateral (H) (Anaes.) (Assist.)

922.35

49845

Foot, arthrodesis of, first metatarsophalangeal joint, with synovectomy if performed (H) (Anaes.) (Assist.)

485.40

49848

Foot, correction of claw or hammer toe (Anaes.)

165.05

49851

Foot, correction of claw or hammer toe with internal fixation (H) (Anaes.)

213.45

49854

Foot, radical plantar fasciotomy or fasciectomy of (H) (Anaes.) (Assist.)

388.30

49857

Foot, metatarsophalangeal joint replacement (H) (Anaes.) (Assist.)

359.20

49860

Foot, synovectomy of metatarsophalangeal joint, single joint (H) (Anaes.) (Assist.)

291.15

49863

Foot, synovectomy of metatarsophalangeal joint, 2 or more joints (H) (Anaes.) (Assist.)

437.00

49866

Foot, neurectomy for plantar or digital neuritis (Morton’s or Bett’s syndrome) (H) (Anaes.) (Assist.)

310.45

49878

Talipes equinovarus, calcaneo valgus or metatarsus varus, treatment by cast, splint or manipulation—each attendance (Anaes.)

58.25

50100

Joint, diagnostic arthroscopy of (including biopsy), other than a service to which another item in this Group applies and other than a service associated with another arthroscopic procedure (Anaes.) (Assist.)

281.45

50102

Joint, arthroscopic surgery of, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

631.05

50103

Joint, arthrotomy of, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

339.85

50104

Joint, synovectomy of, other than a service to which another item in this Group applies (Anaes.) (Assist.)

322.05

50106

Joint, stabilisation of, involving one or more of repair of capsule, repair of ligament or internal fixation, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

485.40

50109

Joint, arthrodesis of, other than a service to which another item in this Group applies, with synovectomy if performed (H) (Anaes.) (Assist.)

485.40

50112

Cicatricial flexion or extension contraction of joint, correction of, involving tissues deeper than skin and subcutaneous tissue, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

372.35

50115

Joint or joints, manipulation of, performed in the operating theatre of a hospital, other than a service associated with a service to which another item in this Group applies (H) (Anaes.)

147.45

50118

Subtalar joint, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)

446.50

50121

Greater trochanter, transplantation of ileopsoas tendon to (H) (Anaes.) (Assist.)

873.80

50127

Joint or joints, arthroplasty of, by any technique other than a service to which another item applies (H) (Anaes.) (Assist.)

724.45

50130

Joint or joints, application of external fixator to, other than for treatment of fractures (H) (Anaes.) (Assist.)

322.05

50200

Aggressive or potentially malignant bone or deep soft tissue tumour, biopsy of (not including aftercare) (Anaes.)

194.05

50201

Aggressive or potentially malignant bone or deep soft tissue tumour involving neurovascular structures, open biopsy of (not including aftercare) (Anaes.) (Assist.)

339.75

50203

Bone or malignant deep soft tissue tumour, lesional or marginal excision of (Anaes.) (Assist.)

427.20

50206

Bone tumour, lesional or marginal excision of, combined with any one of the following:

(a) liquid nitrogen freezing;

(b) autograft;

(c) allograft;

(d) cementation

(H) (Anaes.) (Assist.)

631.05

50209

Bone tumour, lesional or marginal excision of, combined with any 2 or more of the following:

(a) liquid nitrogen freezing;

(b) autograft;

(c) allograft;

(d) cementation

(H) (Anaes.) (Assist.)

776.80

50212

Malignant or aggressive soft tissue tumour affecting the long bones of leg or arm, enbloc resection of, with compartmental or wide excision of soft tissue, without reconstruction (H) (Anaes.) (Assist.)

1,699.00

50215

Malignant or aggressive soft tissue tumour affecting the long bones of leg or arm, enbloc resection of, with compartmental or wide excision of soft tissue, with intercalary reconstruction (prosthesis, allograft or autograft) (H) (Anaes.) (Assist.)

2,135.90

50218

Malignant tumour of long bone, enbloc resection of, with replacement or arthrodesis of adjacent joint, with synovectomy if performed (H) (Anaes.) (Assist.)

2,815.60

50221

Malignant or aggressive soft tissue tumour of pelvis, sacrum or spine, or scapula and shoulder, enbloc resection of (H) (Anaes.) (Assist.)

2,621.25

50224

Malignant or aggressive soft tissue tumour of pelvis, sacrum or spine, or scapula and shoulder, enbloc resection of, with reconstruction by prosthesis, allograft or autograft (Anaes.) (Assist.)

2,912.60

50227

Malignant bone tumour, enbloc resection of, with massive anatomic specific allograft or autograft, with or without prosthetic replacement (H) (Anaes.) (Assist.)

3,398.00

50230

Benign tumour, resection of, requiring anatomic specific allograft, with or without internal fixation (H) (Anaes.) (Assist.)

1,747.55

50233

Malignant tumour, amputation for, hemipelvectomy or interscapulothoracic (H) (Anaes.) (Assist.)

2,233.00

50236

Malignant tumour, amputation for, hip disarticulation, shoulder disarticulation or proximal third femur (H) (Anaes.) (Assist.)

1,747.55

50239

Malignant tumour, amputation for, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)

1,164.90

50300

Joint deformity, slow correction of, using ring fixator or similar device, including all associated attendances—applicable once in a 12 month period (H) (Anaes.) (Assist.)

1,193.85

50303

Limb lengthening, not more than 5 cm, by gradual distraction, applying an external fixator or intra medullary device in the operating theatre of a hospital (H) (Anaes.) (Assist.)

1,630.00

50306

Limb lengthening, if:

(a) the lengthening is bipolar; or

(b) bone transport is carried out; or

(c) the fixator is extended to correct an adjacent joint deformity; or

(d) the lengthening is more than 5cm

(Anaes.) (Assist.)

2,545.00

50309

Ring fixator or similar device, adjustment of, with or without insertion or removal of fixation pins, performed under general anaesthesia in the operating theatre of a hospital, other than a service to which item 50303 or 50306 applies (H) (Anaes.) (Assist.)

314.60

50312

Ankle, synovectomy of, by arthroscopic or other means—not associated with another arthroscopic procedure of the ankle (H) (Anaes.) (Assist.)

721.95

50315

Talipes equinovarus, posterior release of (H) (Anaes.) (Assist.)

714.95

50318

Talipes equinovarus, medial release of (H) (Anaes.) (Assist.)

714.95

50321

Talipes equinovarus, combined posteromedial release of (H) (Anaes.) (Assist.)

957.85

50324

Talipes equinovarus, combined posteromedial release of, revision procedure (H) (Anaes.) (Assist.)

1,365.55

50327

Talipes equinovarus, bilateral procedures (H) (Anaes.) (Assist.)

1,665.60

50330

Talipes equinovarus, or talus, vertical congenital—postoperative manipulation and change of plaster, performed under general anaesthesia in the operating theatre of a hospital, other than a service to which item 50315, 50318, 50321, 50324 or 50327 applies (H) (Anaes.)

235.85

50333

Tarsal coalition, excision of, with interposition of muscle, fat graft or similar graft (H) (Anaes.) (Assist.)

636.10

50336

Talus, vertical, congenital, combined anterior and posterior reconstruction (H) (Anaes.) (Assist.)

950.85

50339

Foot and ankle, tibialis anterior tendon (split or whole) transfer to lateral column (H) (Anaes.) (Assist.)

579.10

50342

Foot and ankle, tibialis or tibialis posterior tendon transfer, through the interosseous membrane to anterior or posterior aspect of foot (H) (Anaes.) (Assist.)

672.00

50345

Hyperextension deformity of toe, release incorporating VY plasty of skin, lengthening of extensor tendons and release of capsule contracture (H) (Anaes.) (Assist.)

357.50

50348

Knee, deformity of, postoperative manipulation and change of plaster, performed under general anaesthesia in the operating theatre of a hospital (H) (Anaes.)

235.85

50349

Hip, congenital dislocation of, treatment of, by closed reduction (Anaes.) (Assist.)

330.15

50351

Hip, developmental dislocation of, open reduction of (H) (Anaes.) (Assist.)

1,647.15

50352

Hip, congenital dislocation of, treatment of, involving supervision of splint, harness or cast—each attendance (Anaes.)

58.25

50353

Hip spica, initial application of, for congenital dislocation of hip (excluding aftercare) (H) (Anaes.) (Assist.)

365.90

50354

Tibia, pseudarthrosis of, congenital, resection and internal fixation (Anaes.) (Assist.)

1,351.05

50357

Knee, leg or thigh, rectus femoris tendon transfer or medial or lateral hamstring tendon transfer (H) (Anaes.) (Assist.)

579.10

50360

Knee, leg or thigh, combined medial and lateral hamstring tendon transfer (H) (Anaes.) (Assist.)

672.00

50363

Knee, contracture of, posterior release involving multiple tendon lengthening or tenotomies, unilateral (H) (Anaes.) (Assist.)

514.65

50366

Knee, contracture of, posterior release involving multiple tendon lengthening or tenotomies, bilateral (H) (Anaes.) (Assist.)

900.75

50369

Knee, contracture of, posterior release involving multiple tendon lengthening with or without tenotomies and release of joint capsule with or without cruciate ligaments, unilateral (H) (Anaes.) (Assist.)

672.00

50372

Knee, contracture of, posterior release involving multiple tendon lengthening with or without tenotomies and release of joint capsule with or without cruciate ligaments, bilateral (H) (Anaes.) (Assist.)

1,179.55

50375

Hip, contracture of, medial release, involving lengthening of, or division of, the adductors and psoas with or without division of the obturator nerve, unilateral (H) (Anaes.) (Assist.)

514.65

50378

Hip, contracture of, medial release, involving lengthening of, or division of the adductors and psoas with or without division of the obturator nerve, bilateral (H) (Anaes.) (Assist.)

900.75

50381

Hip, contracture of, anterior release, involving lengthening of, or division of the hip flexors and psoas with or without division of the joint capsule, unilateral (H) (Anaes.) (Assist.)

672.00

50384

Hip, contracture of, anterior release, involving lengthening of, or division of the hip flexors and psoas with or without division of the joint capsule, bilateral (H) (Anaes.) (Assist.)

1,179.55

50387

Hip, iliopsoas tendon transfer to greater trochanter, or transfer of abdominal musculature to greater trochanter, or transfer or adductors to ischium (H) (Anaes.) (Assist.)

672.00

50390

Perthes, cerebral palsy, or other neuromuscular conditions, affecting hips or knees, application of cast under general anaesthesia, performed in the operating theatre of a hospital (H) (Anaes.)

235.85

50393

Pelvis, bone graft or shelf procedures for acetabular dysplasia (H) (Anaes.) (Assist.)

872.05

50394

Acetabular dysplasia, treatment of, by multiple periacetabular osteotomy, including internal fixation, if performed (H) (Anaes.) (Assist.)

2,864.10

50396

Hand, congenital abnormalities or duplication of digits, amputation or splitting of phalanx or phalanges, with ligament or joint reconstruction (H) (Anaes.) (Assist.)

479.10

50399

Forearm, radial aplasia or dysplasia (radial club hand), centralisation or radialisation of (H) (Anaes.) (Assist.)

950.85

50402

Torticollis, bipolar release of sternocleidomastoid muscle and associated soft tissue (H) (Anaes.) (Assist.)

436.15

50405

Elbow, flexorplasty, or tendon transfer to restore elbow function (H) (Anaes.) (Assist.)

593.35

50408

Shoulder, congenital or developmental dislocation, open reduction of (H) (Anaes.) (Assist.)

1,029.40

50411

Lower limb deficiency, treatment of congenital deficiency of the femur by resection of the distal femur and proximal tibia followed by knee fusion (Anaes.) (Assist.)

1,351.05

50414

Lower limb deficiency, treatment of congenital deficiency of the femur by resection of the distal femur and proximal tibia followed by knee fusion and rotationplasty (Anaes.) (Assist.)

1,822.85

50417

Lower limb deficiency, treatment of congenital deficiency of the tibia by reconstruction of the knee, involving transfer of fibula or tibia, and repair of quadriceps mechanism (Anaes.) (Assist.)

1,351.05

50420

Patella, congenital dislocation of, reconstruction of the quadriceps (H) (Anaes.) (Assist.)

1,115.15

50423

Tibia, fibula or both, congenital deficiency of, transfer of the fibula to tibia, with internal fixation (Anaes.) (Assist.)

1,029.40

50426

Diaphyseal aclasia, removal of lesion or lesions from bone—one approach (H) (Anaes.) (Assist.)

479.10

50450

Unilateral single event multilevel surgery, for a patient less than 18 years of age with hemiplegic cerebral palsy, comprising 3 or more of the following:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening;

(b) correction of muscle imbalance by transfer of a tendon or tendons;

(c) correction of femoral torsion by rotational osteotomy of the femur;

(d) correction of tibial torsion by rotational osteotomy of the tibia;

(e) correction of joint instability by varus derotation osteotomy of the femur, subtalar arthrodesis with synovectomy if performed, or os calcis lengthening;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H) (Anaes.) (Assist.)

1,265.25

50451

Unilateral single event multilevel surgery, for a patient less than 18 years of age with hemiplegic cerebral palsy, comprising 3 or more of the following:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening;

(b) correction of muscle imbalance by transfer of a tendon or tendons;

(c) correction of femoral torsion by rotational osteotomy of the femur;

(d) correction of tibial torsion by rotational osteotomy of the tibia;

(e) correction of joint instability by varus derotation osteotomy of the femur, subtalar arthrodesis with synovectomy if performed, or os calcis lengthening;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) (Anaes.) (Assist.)

1,265.25

50455

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H) (Anaes.) (Assist.)

1,432.80

50456

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) (Anaes.) (Assist.)

1,432.80

50460

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery and bilateral femoral osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of torsional abnormality of the femur by rotational osteotomy and internal fixation;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H) (Anaes.) (Assist.)

2,139.25

50461

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery and bilateral femoral osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of torsional abnormality of the femur by rotational osteotomy and internal fixation;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) (Anaes.) (Assist.)

2,139.25

50465

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies and bilateral tibial osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H) (Anaes.) (Assist.)

3,013.10

50466

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies and bilateral tibial osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) (Anaes.) (Assist.)

3,013.10

50470

Bilateral single event multilevel surgery, for a patient less than 18 years of age with cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies, bilateral tibial osteotomies and bilateral foot stabilisation, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation; and

(e) correction of bilateral pes valgus by os calcis lengthening or subtalar fusion;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H) (Anaes.) (Assist.)

3,821.30

50471

Bilateral single event multilevel surgery, for a patient less than 18 years of age with cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies, bilateral tibial osteotomies and bilateral foot stabilisation, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation; and

(e) correction of bilateral pes valgus by os calcis lengthening or subtalar fusion;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) (Anaes.) (Assist.)

3,821.30

50475

Single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, for the correction of crouch gait, including:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of flexion deformity at the knee by extension osteotomy of the distal femur including internal fixation; and

(d) correction of patella alta and quadriceps insufficiency by patella tendon shortening or reconstruction; and

(e) correction of tibial torsion by rotational osteotomy of the tibia with internal fixation; and

(f) correction of foot instability by os calcis lengthening or subtalar fusion;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H) (Anaes.) (Assist.)

4,409.40

50476

Single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, for the correction of crouch gait including:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of flexion deformity at the knee by extension osteotomy of the distal femur including internal fixation; and

(d) correction of patella alta and quadriceps insufficiency by patella tendon shortening or reconstruction; and

(e) correction of tibial torsion by rotational osteotomy of the tibia with internal fixation; and

(f) correction of foot instability by os calcis lengthening or subtalar fusion;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) (Anaes.) (Assist.)

4,409.40

50500

Radius or ulna, distal end of, with open growth plate, treatment of fracture of, by closed reduction (Anaes.)

285.30

50504

Radius or ulna, distal end of, with open growth plate, treatment of fracture of, by open reduction (Anaes.) (Assist.)

380.55

50508

Radius, distal end of, with open growth plate, treatment of Colles’, Smith’s or Barton’s fracture of, by closed reduction (Anaes.)

407.55

50512

Radius, distal end of, with open growth plate, treatment of Colles’, Smith’s or Barton’s fracture of, by open reduction (H) (Anaes.) (Assist.)

543.80

50516

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (H) (Anaes.)

366.95

50520

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

489.25

50524

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radioulnar joint or proximal radiohumeral joint (Galeazzi or Monteggia injury), by closed reduction undertaken in the operating theatre of a hospital (H) (Anaes.) (Assist.)

421.30

50528

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radioulnar joint or proximal radiohumeral joint (Galeazzi or Monteggia injury), by reduction with or without internal fixation by open or percutaneous means (H) (Anaes.) (Assist.)

679.60

50532

Radius and ulna, shafts of, with open growth plates, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (H) (Anaes.)

591.30

50536

Radius and ulna, shafts of, with open growth plates, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

788.30

50540

Olecranon, with open growth plate, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

543.80

50544

Radius, with open growth plate, treatment of fracture of head or neck of, by closed reduction of (Anaes.)

271.80

50548

Radius, with open growth plate, treatment of fracture of head or neck of, by reduction with or without internal fixation by open or percutaneous means (H) (Anaes.) (Assist.)

543.80

50552

Humerus, proximal, with open growth plate, treatment of fracture of, by closed reduction, undertaken in the operating theatre, neonatal unit or nursery of a hospital (H) (Anaes.)

469.00

50556

Humerus, proximal, with open growth plate, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)

625.15

50560

Humerus, shaft of, with open growth plate, treatment of fracture of, by closed reduction, undertaken in the operating theatre, neonatal unit or nursery of a hospital (H) (Anaes.)

489.25

50564

Humerus, shaft of, with open growth plate, treatment of fracture of, by internal or external fixation (H) (Anaes.) (Assist.)

652.40

50568

Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)

570.90

50572

Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means, undertaken in the operating theatre of a hospital (H) (Anaes.) (Assist.)

761.15

50576

Femur, with open growth plate, treatment of fracture of, by closed reduction or traction (Anaes.) (Assist.)

625.15

50580

Tibia, with open growth plate, plateau or condyles, medial or lateral, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H) (Anaes.) (Assist.)

652.40

50584

Tibia, distal, with open growth plate, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H) (Anaes.) (Assist.)

625.15

50588

Tibia and fibula, with open growth plates, treatment of fracture of, by internal fixation (H) (Anaes.) (Assist.)

815.40

50600

Scoliosis or kyphosis, in a child, manipulation of deformity and application of a localiser cast, under general anaesthesia, in a hospital (H) (Anaes.) (Assist.)

448.25

50604

Scoliosis or kyphosis, in a child or adolescent, spinal fusion for (without instrumentation) (H) (Anaes.) (Assist.)

1,902.65

50608

Scoliosis or kyphosis, in a child or adolescent, treatment by segmental instrumentation and fusion of the spine, other than a service to which any of items 51011 to 51171 apply (H) (Anaes.) (Assist.)

3,534.05

50612

Scoliosis or kyphosis, in a child or adolescent, with spinal deformity, treatment by segmental instrumentation, utilising separate anterior and posterior approaches, other than a service to which any of items 51011 to 51171 apply (H) (Anaes.) (Assist.)

5,026.80

50616

Scoliosis, in a child or adolescent, reexploration for adjustment or removal of segmental instrumentation used for correction of spine deformity (H) (Anaes.) (Assist.)

638.70

50620

Scoliosis, in a child or adolescent, revision of failed scoliosis surgery, involving more than one of osteotomy, fusion, removal of instrumentation or instrumentation, other than a service to which any of items 51011 to 51171 apply (H) (Anaes.) (Assist.)

3,534.05

50624

Scoliosis, in a child or adolescent, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar)—not more than 4 levels (H) (Anaes.) (Assist.)

3,534.05

50628

Scoliosis, in a child or adolescent, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar)—more than 4 levels (H) (Anaes.) (Assist.)

4,365.45

50632

Scoliosis or kyphosis, in a child or adolescent, requiring segmental instrumentation and fusion of the spine down to and including the pelvis or sacrum, other than a service to which any of items 51011 to 51171 apply (H) (Anaes.) (Assist.)

3,669.85

50636

Scoliosis, in a child or adolescent, requiring anterior decompression of the spinal cord with vertebral resection and instrumentation in the presence of spinal cord involvement, other than a service to which any of items 51011 to 51171 apply (H) (Anaes.) (Assist.)

4,077.60

50640

Scoliosis, in a child or adolescent, congenital, resection and fusion of abnormal vertebra via an anterior or posterior approach, other than a service to which any of items 51011 to 51171 apply (H) (Anaes.) (Assist.)

2,254.05

50644

Spine, bone graft to, for a child or adolescent, associated with surgery for correction of scoliosis or kyphosis or both (H) (Anaes.) (Assist.)

2,174.85

50650

Hip dysplasia or dislocation, in a child, examination, manipulation and arthrography of the hip under anaesthesia (Anaes.)

427.70

50654

Hip dysplasia or dislocation, in a child, application or reapplication of a hip spica, including examination of the hip (H) (Assist.) (Anaes.)

512.15

50658

Hip dysplasia or dislocation, in a child, examination and manipulation of the hip under anaesthesia (Anaes.)

203.90

Subgroup 16—Radiofrequency and microwave tissue ablation

50950

Unresectable primary malignant tumour of the liver, destruction of, by percutaneous radiofrequency ablation or percutaneous microwave tissue ablation (including any associated imaging services), other than a service associated with a service to which item 30419 or 50952 applies (Anaes.)

842.60

50952

Unresectable primary malignant tumour of the liver, destruction of, by open or laparoscopic radiofrequency ablation or open or laparoscopic microwave tissue ablation (including any associated imaging services), if a multidisciplinary team has assessed that percutaneous radiofrequency ablation or percutaneous microwave tissue ablation cannot be performed or is not practical because of one or more of the following clinical circumstances:

(a) percutaneous access cannot be achieved;

(b) vital organs or tissues are at risk of damage from the percutaneous radiofrequency ablation or percutaneous microwave tissue ablation procedure;

(c) resection of one part of the liver is possible, however there is at least one primary liver tumour in an unresectable portion of the liver that is suitable for radiofrequency ablation or microwave tissue ablation;

other than a service associated with a service to which item 30419 or 50950 applies (Anaes.)

842.60

Subgroup 17—Spinal surgery

51011

Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.)

1,480.35

51012

 

Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.)

1,973.55

51013

Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, 3 motion segments, not being a service associated with a service to which item 51011, 51012, 51014 or 51015 applies (H) (Anaes.) (Assist.)

2,467.00

51014

Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51015 applies (H) (Anaes.) (Assist.)

2,960.40

51015

Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, more than 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51014 applies (H) (Anaes.) (Assist.)

3,453.80

51020

Simple fixation of part of one vertebra (not motion segment) including pars interarticularis, spinous process or pedicle, or simple interspinous wiring between 2 adjacent vertebral levels, not being a service associated with:

(a) interspinous dynamic stabilisation devices; or

(b) a service to which item 51021, 51022, 51023, 51024, 51025 or 51026 applies

(H) (Anaes.) (Assist.)

789.35

51021

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, one motion segment, not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.)

1,321.25

51022

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 2 motion segments, not being a service associated with a service to which item 51020, 51021, 51023, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.)

1,643.50

51023

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 3 or 4 motion segments, not being a service associated with a service to which item 51020, 51021, 51022, 51024, 51025 or 51026 applies (H) (Anaes.) (Assist.)

1,955.85

51024

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 5 or 6 motion segments, not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51025 or 51026 applies (H) (Anaes.) (Assist.)

2,258.00

51025

 

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 7 to 12 motion segments, not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51026 applies (H) (Anaes.) (Assist.)

2,639.15

51026

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, more than 12 motion segments, not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51025 applies (H) (Anaes.) (Assist.)

2,889.45

51031

Spine, posterior and/or posterolateral bone graft to, one motion segment, not being a service associated with a service to which item 51032, 51033, 51034, 51035 or 51036 applies (H) (Anaes.) (Assist.)

970.85

51032

Spine, posterior and/or posterolateral bone graft to, 2 motion segments, not being a service associated with a service to which item 51031, 51033, 51034, 51035 or 51036 applies (H) (Anaes.) (Assist.)

1,165.05

51033

Spine, posterior and/or posterolateral bone graft to, 3 motion segments, not being a service associated with a service to which item 51031, 51032, 51034, 51035 or 51036 applies (H) (Anaes.) (Assist.)

1,359.25

51034

Spine, posterior and/or posterolateral bone graft to, 4 to 7 motion segments, not being a service associated with a service to which item 51031, 51032, 51033, 51035 or 51036 applies (H) (Anaes.) (Assist.)

1,456.30

51035

Spine, posterior and/or posterolateral bone graft to, 8 to 11 motion segments, not being a service associated with a service to which item 51031, 51032, 51033, 51034 or 51036 applies (H) (Anaes.) (Assist.)

1,553.35

51036

Spine, posterior and/or posterolateral bone graft to, 12 or more motion segments, not being a service associated with a service to which item 51031, 51032, 51033, 51034 or 51035 applies (H) (Anaes.) (Assist.)

1,650.50

51041

 

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.)

1,116.50

51042

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies (H) (Anaes.) (Assist.)

1,563.15

51043

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 3 motion segments, not being a service associated with a service to which item 51041, 51042, 51044 or 51045 applies (H) (Anaes.) (Assist.)

1,953.95

51044

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 4 motion segments, not being a service associated with a service to which item 51041, 51042, 51043 or 51045 applies (H) (Anaes.) (Assist.)

2,121.40

51045

 

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 5 or more motion segments, not being a service associated with a service to which item 51041, 51042, 51043 or 51044 applies (H) (Anaes.) (Assist.)

2,233.05

51051

Pedicle subtraction osteotomy, one vertebra, not being a service associated with a service to which item 51052, 51053, 51054, 51055, 51056, 51057, 51058 or 51059 applies (H) (Anaes.) (Assist.)

1,907.80

51052

Pedicle subtraction osteotomy, 2 vertebrae, not being a service associated with a service to which item 51051, 51053, 51054, 51055, 51056, 51057, 51058 or 51059 applies (H) (Anaes.) (Assist.)

2,320.30

51053

Vertebral column resection osteotomy performed through single posterior approach, one vertebra, not being a service associated with a service to which item 51051, 51052, 51054, 51055, 51056, 51057, 51058 or 51059 applies (H) (Anaes.) (Assist.)

2,639.95

51054

Vertebral body, piecemeal or subtotal excision of (where piecemeal or subtotal excision is defined as removal of more than 50% of the vertebral body), one vertebra, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51055, 51056, 51057, 51058 or 51059 applies

(H) (Anaes.) (Assist.)

1,407.65

51055

Vertebral body, piecemeal or subtotal excision of (where piecemeal or subtotal excision is defined as removal of more than 50% of the vertebral body), 2 vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51056, 51057, 51058 or 51059 applies

(H) (Anaes.) (Assist.)

2,111.45

51056

Vertebral body, piecemeal or subtotal excision of (where piecemeal or subtotal excision is defined as removal of more than 50% of the vertebral body), 3 or more vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51057, 51058 or 51059 applies

(H) (Anaes.) (Assist.)

2,463.35

51057

Vertebral body, en bloc excision of (complete spondylectomy), one vertebra, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51056, 51058 or 51059 applies

(H) (Anaes.) (Assist.)

2,475.00

51058

Vertebral body, en bloc excision of (complete spondylectomy), 2 vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51056, 51057 or 51059 applies

(H) (Anaes.) (Assist.)

2,784.85

51059

Vertebral body, en bloc excision of (complete spondylectomy), 3 or more vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51056, 51057 or 51058 applies

(H) (Anaes.) (Assist.)

3,403.10

51061

Spinal fusion, anterior and posterior, including spinal instrumentation at one motion segment, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51062, 51063, 51064, 51065 or 51066 applies (H) (Anaes.) (Assist.)

2,923.20

51062

Spinal fusion, anterior and posterior, including spinal instrumentation at 2 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51063, 51064, 51065 or 51066 applies (H) (Anaes.) (Assist.)

3,789.15

51063

Spinal fusion, anterior and posterior, including spinal instrumentation at 3 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51062, 51064, 51065 or 51066 applies (H) (Anaes.) (Assist.)

4,589.35

51064

Spinal fusion, anterior and posterior, including spinal instrumentation at 4 to 7 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51062, 51063, 51065 or 51066 applies (H) (Anaes.) (Assist.)

5,107.60

51065

Spinal fusion, anterior and posterior, including spinal instrumentation at 8 to 11 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51062, 51063, 51064 or 51066 applies (H) (Anaes.) (Assist.)

5,648.95

51066

Spinal fusion, anterior and posterior, including spinal instrumentation at 12 or more motion segments, posterior and/or posterolateral bone graft, and anterior column fusion not being a service associated with a service to which item 51061, 51062, 51063, 51064 or 51065 applies (H) (Anaes.) (Assist.)

5,947.70

51071

Removal of intradural lesion, not being a service associated with a service to which item 51072 or 51073 applies (H) (Anaes.) (Assist.)

2,578.10

51072

Craniocervical junction lesion, transoral approach for, not being a service associated with a service to which item 51071 or 51073 applies (H) (Anaes.) (Assist.)

2,681.20

51073

Removal of intramedullary tumour or arteriovenous malformation, not being a service associated with a service to which item 51071 or 51072 applies (H) (Anaes.) (Assist.)

3,403.10

51102

Thoracoplasty in combination with thoracic scoliosis correction—3 or more ribs (H) (Anaes.) (Assist.)

1,220.40

51103

Odontoid screw fixation (H) (Anaes.) (Assist.)

2,144.75

51110

Spine, treatment of fracture, dislocation or fracturedislocation, with immobilisation by calipers or halo, not including application of skull tongs or calipers as part of operative positioning (Anaes.)

776.80

51111

Skull calipers or halo, insertion of, as an independent procedure (H) (Anaes.)

330.15

51112

Plaster jacket, application of, as an independent procedure (Anaes.)

223.25

51113

Halo, application of, in addition to spinal fusion for scoliosis, or other conditions (H) (Anaes.)

247.55

51114

Halothoracic orthosis—application of both halo and thoracic jacket (H) (Anaes.)

437.00

51115

Halofemoral traction, as an independent procedure (Anaes.)

437.00

51120

Bone graft, harvesting of autogenous graft, via separate incision or via subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine (H) (Anaes.)

242.85

51130

Lumbar artificial intervertebral total disc replacement, at one motion segment only, including removal of disc and marginal osteophytes:

(a) for a patient who:

(i) has not had prior spinal fusion surgery at the same lumbar level; and

(ii) does not have vertebral osteoporosis; and

(iii) has failed conservative therapy; and

(b) not being a service associated with a service to which item 51011, 51012, 51013, 51014 or 51015 applies

(H) (Anaes.) (Assist.)

1,849.70

51131

Cervical artificial intervertebral total disc replacement, at one motion segment only, including removal of disc and marginal osteophytes, for a patient who:

(a) has not had prior spinal surgery at the same cervical level; and

(b) is skeletally mature; and

(c) has symptomatic degenerative disc disease with radiculopathy; and

(d) does not have vertebral osteoporosis; and

(e) has failed conservative therapy

(H) (Anaes.) (Assist.)

1,116.50

51140

Previous spinal fusion, reexploration for, involving adjustment or removal of instrumentation up to 3 motion segments, not being a service associated with a service to which item 51141 applies (H) (Anaes.) (Assist.)

456.30

51141

Previous spinal fusion, reexploration for, involving adjustment or removal of instrumentation more than 3 motion segments, not being a service associated with a service to which item 51140 applies (H) (Anaes.) (Assist.)

844.10

51145

Wound debridement or excision for postoperative infection or haematoma following spinal surgery (H) (Anaes.) (Assist.)

456.30

51150

Coccyx, excision of (H) (Anaes.) (Assist.)

459.35

51160

Anterior exposure of thoracic or lumbar spine, one motion segment, not being a service to which item 51165 applies (H) (Anaes.) (Assist.)

1,185.95

51165

Anterior exposure of thoracic or lumbar spine, more than one motion segment, not being a service to which item 51160 applies (H) (Anaes.) (Assist.)

1,495.30

51170

Syringomyelia or hydromyelia, craniotomy for, with or without duraplasty, intradural dissection, plugging of obex or local cerebrospinal fluid shunt (H) (Anaes.) (Assist.)

2,252.85

51171

Syringomyelia or hydromyelia, treatment by direct cerebrospinal fluid shunt (for example, syringosubarachnoid shunt, syringopleural shunt or syringoperitoneal shunt) (H) (Anaes.) (Assist.)

946.10

 

Division 5.11Group T9: Assistance at operations

5.11.1  Meaning of amount under clause 5.11.1

  In item 51303:

amount under clause 5.11.1, for assistance at an operation or series of operations, means 20% of the sum of the fees payable under the Act for the services provided at that operation, or series of operations, by the practitioner to whom the assistance was given.

5.11.2  Meaning of amount under clause 5.11.2

  In item 51309:

amount under clause 5.11.2, for assistance at a series or combination of operations, means:

 (a) 20% of the sum of the fees payable under the Act for the services provided at those operations by the practitioner to whom the assistance was given; or

 (b) for the caesarean section component of the operations—the fee mentioned in item 16520.

5.11.3  Meaning of amount under clause 5.11.3

  In item 51312:

amount under clause 5.11.3, for assistance at a procedure, means 20% of the sum of the fees payable under the Act for the services provided at that procedure by the practitioner to whom the assistance was given.

5.11.4  Restrictions on items in Group T9—medical practitioner providing assistance at operations

  Items 51300 to 51318 apply only to assistance rendered by a medical practitioner other than:

 (a) the practitioner performing the operation; or

 (b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or

 (c) the assistant anaesthetist, if any.

5.11.5  Items in Group T9

  This clause sets out items in Group T9.

 

Group T9—Assistance at operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

51300

Assistance at any operation mentioned in an item in Group T8 that includes “(Assist.)” for which the fee does not exceed $575.75 or at a series or combination of operations mentioned in an item in Group T8 that include “(Assist.)” for which the aggregate fee does not exceed $575.75

89.00

51303

Assistance at any operation mentioned in an item in Group T8 that includes “(Assist.)” for which the fee exceeds $575.75 or at a series or combination of operations mentioned in an item in Group T8 that include “(Assist.)” for which the aggregate fee exceeds $575.75

Amount under clause 5.11.1

51306

Assistance at a birth involving Caesarean section

128.55

51309

Assistance at a series or combination of operations that include “(Assist.)” and assistance at a birth involving Caesarean section

Amount under clause 5.11.2

51312

Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627

Amount under clause 5.11.3

51315

Assistance at cataract and intraocular lens surgery covered by item 42698, 42701, 42702, 42704, 42705 or 42707, when performed in association with services covered by item 42551 to 42569, 42653, 42656, 42725, 42746, 42749, 42752, 42776 or 42779

280.90

51318

Assistance at cataract and intraocular lens surgery, if patient has:

(a) total loss of vision, including no potential for central vision, in the fellow eye; or

(b) one of the following in the fellow eye:

(i) vitreous loss;

(ii) rupture of posterior capsule;

(iii) loss of nuclear material into the vitreous;

(iv) intraocular haemorrhage;

(v) intraocular infection (endophthalmitis);

(vi) cystoid macular oedema;

(vii) corneal decompensation;

(viii) retinal detachment; or

(c) pseudo exfoliation, subluxed lens, iridodonesis, phacodonesis, retinal detachment, corneal scarring, preexisting uveitis, bound down miosed pupil, nanophthalmos, spherophakia, Marfan’s syndrome, homocysteinuria or previous blunt trauma causing intraocular damage

185.40

 

Part 6Oral and maxillofacial services

Division 6.1Preliminary

6.1.1  Restriction on items Groups O1 to O11—providers of services

  Items 51700 to 53706 apply only to a service provided in the course of dental practice by a dental practitioner approved by the Minister before 1 November 2004 for the definition of professional service in subsection 3(1) of the Act.

Division 6.2Group O1: Consultations

6.2.1  Items in Group O1

  This clause sets out items in Group O1.

 

Group O1—Consultations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

51700

Professional attendance by an approved dental practitioner in the practice of oral and maxillofacial surgery—initial attendance at consulting rooms, hospital or residential aged care facility if the patient is referred to the approved dental practitioner

88.20

51703

Professional attendance by an approved dental practitioner in the practice of oral and maxillofacial surgery—an attendance after the initial attendance in a single course of treatment, at consulting rooms, hospital or residential aged care facility if the patient is referred to the approved dental practitioner

44.35

 

Division 6.3Group O2: Assistance at operation

6.3.1  Meaning of amount under clause 6.3.1

  In item 51803:

amount under clause 6.3.1, for assistance at an operation or series of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services provided at that operation, or series of operations, by the practitioner to whom the assistance was given.

6.3.2  Restrictions on items in Group O2—approved dental practitioner providing assistance at operations

  Items 51800 and 51803 apply only to assistance rendered by an approved dental practitioner other than:

 (a) the practitioner performing the operation; or

 (b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or

 (c) the assistant anaesthetist, if any.

6.3.3  Items in Group O2

  This clause sets out items in Group O2.

 

Group O2—Assistance at operation

Column 1

Item

Column 2

Description

Column 3

Fee ($)

51800

Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operation mentioned in an item that includes “(Assist.)” for which the fee does not exceed $575.75 or at a series or combination of operations mentioned in an item in Groups O3 to O9 that include “(Assist.)” for which the aggregate fee does not exceed $575.75

89.00

51803

Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operation mentioned in an item that includes “(Assist.)” for which the fee exceeds $575.75 or at a series or combination of operations mentioned in an item that include “(Assist.)” if the aggregate fee exceeds $575.75

Amount under clause 6.3.1

 

Division 6.4Group O3: General surgery

6.4.1  Items in Group O3

  This clause sets out items in Group O3.

 

Group O3—General surgery

Column 1

Item

Column 2

Description

Column 3

Fee ($)

51900

Wound of soft tissue in the oral and maxillofacial region, deep or extensively contaminated, debridement of, under general anaesthesia or regional or field nerve block, including suturing of that wound when performed (Anaes.) (Assist.)

336.20

51902

Wounds of the oral and maxillofacial region, dressing of, under general anaesthesia, with or without removal of sutures, other than a service associated with a service to which another item in Groups O3 to O9 applies (Anaes.)

76.25

51904

Lipectomy—wedge excision of skin or fat—one excision (Anaes.) (Assist.)

469.10

51906

Lipectomy—wedge excision of skin or fat—2 or more excisions (Anaes.) (Assist.)

713.35

52000

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 cm long), superficial (Anaes.)

85.05

52003

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 cm long), involving deeper tissue (Anaes.)

121.25

52006

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 cm long), superficial (Anaes.)

121.25

52009

Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 cm long), involving deeper tissue (Anaes.)

191.40

52010

Full thickness laceration of ear, eyelid, nose or lip, repair of, with accurate apposition of each layer of tissue (Anaes.) (Assist.)

261.90

52012

Superficial foreign body, removal of, as an independent procedure (Anaes.)

24.25

52015

Subcutaneous foreign body, removal of, requiring incision and suture, as an independent procedure (Anaes.)

113.30

52018

Foreign body in muscle, tendon or other deep tissue, removal of, as an independent procedure (Anaes.) (Assist.)

285.45

52021

Aspiration biopsy of one or more jaw cysts as an independent procedure to obtain material for diagnostic purposes and other than a service associated with an operative procedure on the same day (Anaes.)

30.35

52024

Biopsy of skin or mucous membrane, as an independent procedure (Anaes.)

53.85

52025

Lymph node of neck, biopsy of (Anaes.)

189.65

52027

Biopsy of lymph node, muscle or other deep tissue or organ, as an independent procedure and other than a service to which item 52025 applies (Anaes.)

154.45

52030

Sinus, excision of, involving superficial tissue only (Anaes.)

92.80

52033

Sinus, excision of, involving muscle and deep tissue (Anaes.)

189.65

52034

Premalignant lesions of the oral mucous, treatment by cryotherapy, diathermy or carbon dioxide laser

44.35

52035

Endoscopic laser therapy for neoplasia and benign vascular lesions of the oral cavity (Anaes.)

490.95

52036

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, if the removal is by surgical excision and suture, other than a service to which item 52039 applies (Anaes.)

130.90

52039

Tumours, cysts, ulcers or scars (other than a scar removed during the surgical approach at an operation), up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, if the removal is by surgical excision and suture, and the procedure is performed on more than 3 but not more than 10 lesions (Anaes.) (Assist.)

336.20

52042

Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), more than 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane (Anaes.)

177.90

52045

Tumour, cyst (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5 mm separation between the cyst lining and tooth structure or if a tumour or cyst has been proven by positive histopathology), ulcer or scar (other than a scar removed during the surgical approach at an operation), removal of, other than a service to which another item in Groups O3 to O9 applies, involving muscle, bone, or other deep tissue (Anaes.)

254.20

52048

Tumour or deep cyst (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5 mm separation between the cyst lining and tooth structure or if a tumour or cyst has been proven by positive histopathology), removal of, requiring wide excision, other than a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)

383.10

52051

Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (Anaes.) (Assist.)

517.95

52054

Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (Anaes.) (Assist.)

605.95

52055

Haematoma, small abscess or cellulitis in the oral and maxillofacial region, not requiring admission to a hospital, incision with drainage of (excluding aftercare)

28.20

52056

Haematoma in the oral and maxillofacial region, aspiration of (Anaes.)

28.20

52057

Large haematoma, large abscess, carbuncle, cellulitis or similar lesion in the oral and maxillofacial region, incision with drainage of (excluding aftercare) (H) (Anaes.)

168.05

52058

Percutaneous drainage of deep abscess in the oral and maxillofacial region, using interventional imaging techniques—but not including imaging (Anaes.)

245.00

52059

Abscess in the oral and maxillofacial region drainage tube, exchange of using interventional imaging techniques—but not including imaging (Anaes.)

276.05

52060

Muscle in the oral and maxillofacial region, excision of (Anaes.)

195.35

52061

Muscle, in the oral and maxillofacial region, ruptured, repair of (limited), not associated with external wound (Anaes.)

230.60

52062

Muscle, in the oral and maxillofacial region, ruptured, repair of (extensive), not associated with external wound (Anaes.) (Assist.)

304.95

52063

Bone tumour in the oral and maxillofacial region, innocent, excision of, other than a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)

367.50

52064

Bone cyst in the oral and maxillofacial region, injection into or aspiration of (Anaes.)

174.80

52066

Submandibular gland, extirpation of (Anaes.) (Assist.)

459.35

52069

Sublingual gland, extirpation of (Anaes.)

204.75

52072

Salivary gland, dilatation or diathermy of duct (Anaes.)

60.65

52073

Salivary gland, repair of cutaneous fistula of (Anaes.)

154.45

52075

Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, one or more such procedures (Anaes.)

154.45

52078

Tongue, partial excision of (Anaes.) (Assist.)

304.95

52081

Tongue tie, division or excision of frenulum (Anaes.)

47.95

52084

Tongue tie, mandibular frenulum or maxillary frenulum, division or excision of frenulum, in a person aged not less than 2 years (Anaes.)

123.20

52087

Ranula or mucous cyst of mouth, removal of (Anaes.)

211.10

52090

Operation on mandible or maxilla (other than alveolar margins) for chronic osteomyelitis—one bone or in combination with adjoining bones (Anaes.) (Assist.)

367.50

52092

Operation on skull for osteomyelitis (Anaes.) (Assist.)

479.05

52094

Operation on any combination of adjoining bones in the oral and maxillofacial region, being bones referred to in item 52092 (Anaes.) (Assist.)

605.90

52095

Bone growth stimulator in the oral and maxillofacial region, insertion of (Anaes.) (Assist.)

392.70

52096

Orthopaedic pin or wire, insertion of, into maxilla or mandible or zygoma, as an independent procedure (Anaes.)

116.35

52097

External fixation in the oral and maxillofacial region, removal of, in the operating theatre of a hospital (H) (Anaes.)

165.05

52098

External fixation in the oral and maxillofacial region, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)

194.05

52099

Buried wire, pin or screw, one or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, other than a service associated with a service to which item 52102 or 52105 applies (Anaes.)

145.65

52102

Buried wire, pin or screw, one or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, if undertaken in the operating theatre of a hospital, per bone (Anaes.)

145.65

52105

Plate, one or more of, and associated screw and wire which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, other than a service associated with a service to which item 52099 or 52102 applies (Anaes.) (Assist.)

271.80

52106

Arch bars, one or more, which were inserted for dental fixation purposes to the maxilla or mandible, removal of, requiring general anaesthesia if undertaken in the operating theatre of a hospital (H) (Anaes.)

112.30

52108

Lip, full thickness wedge excision of, with repair by direct sutures (Anaes.) (Assist.)

336.20

52111

Vermilionectomy (Anaes.) (Assist.)

336.20

52114

Mandible or maxilla, segmental resection of, for tumours or cysts (Anaes.) (Assist.)

605.95

52117

Mandible, including lower border, or maxilla, subtotal resection of (Anaes.) (Assist.)

721.30

52120

Mandible, hemimandiblectomy of, including condylectomy, if performed (Anaes.) (Assist.)

853.15

52122

Mandible, hemimandibular reconstruction of, or maxilla reconstruction of, with bone graft, plate, tray or alloplast, other than a service associated with a service to which item 52123 applies (Anaes.) (Assist.)

853.15

52123

Mandible, total resection of both sides, including condylectomies if performed (Anaes.) (Assist.)

965.80

52126

Maxilla, total resection of (Anaes.) (Assist.)

928.55

52129

Maxilla, total resection of both maxillae (Anaes.) (Assist.)

1,243.05

52130

Bone graft in the oral and maxillofacial region, other than a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)

456.30

52131

Bone graft with internal fixation, in the oral and maxillofacial region, other than a service to which another item in the range 51900 to 52186, or the range 52303 to 53460, applies (Anaes.) (Assist.)

631.05

52132

Tracheostomy (Anaes.)

256.75

52133

Cricothyrostomy by direct stab or Seldinger technique, using mini tracheostomy device (Anaes.)

93.90

52135

Postoperative or postnasal haemorrhage, or both, control of, if undertaken in the operating theatre of a hospital (H) (Anaes.)

148.85

52138

Maxillary artery, ligation of (Anaes.) (Assist.)

462.60

52141

Facial, mandibular or lingual artery or vein or artery and vein, ligation of, other than a service to which item 52138 applies (Anaes.) (Assist.)

457.55

52144

Foreign body, deep, removal of using interventional imaging techniques (Anaes.) (Assist.)

426.45

52147

Duct of major salivary gland, transposition of (Anaes.) (Assist.)

402.45

52148

Parotid duct, repair of, using microsurgical techniques (Anaes.) (Assist.)

711.35

52158

Submandibular ducts, relocation of, for surgical control of drooling (Anaes.) (Assist.)

1,145.35

52180

Aggressive or potentially malignant bone or deep soft tissue tumour in the oral and maxillofacial region, biopsy of (not including aftercare) (Anaes.)

194.05

52182

Bone or malignant deep soft tissue tumour in the oral and maxillofacial region, lesional or marginal excision of (Anaes.) (Assist.)

427.20

52184

Bone tumour in the oral and maxillofacial region, lesional or marginal excision of, combined with any one of liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)

631.05

52186

Bone tumour in the oral and maxillofacial region, lesional or marginal excision of, combined with any 2 or more of liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)

776.80

 

Division 6.5Group O4: Plastic and reconstructive

6.5.1  Meaning of maxilla

  In items 52342 to 52375:

maxilla includes the zygoma.

6.5.2  Items in Group O4

  This clause sets out items in Group O4.

 

Group O4—Plastic and reconstructive

Column 1

Item

Column 2

Description

Column 3

Fee ($)

52300

Singlestage local flap, if indicated, repair to one defect, with skin or mucosa (Anaes.) (Assist.)

293.25

52303

Singlestage local flap, if indicated, repair to one defect, with buccal pad of fat (Anaes.) (Assist.)

418.75

52306

Singlestage local flap, if indicated, repair to one defect, using temporalis muscle (Anaes.) (Assist.)

621.30

52309

Free grafting (mucosa or split skin) of a granulating area (Anaes.)

211.10

52312

Free grafting (mucosa, split skin or connective tissue) to one defect, including elective dissection (Anaes.) (Assist.)

293.25

52315

Free grafting, full thickness, to one defect (mucosa or skin) (Anaes.) (Assist.)

488.55

52318

Bone graft, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies—Autogenous, small quantity (Anaes.)

145.65

52319

Bone graft, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies—Autogenous, large quantity (Anaes.)

242.85

52321

Foreign implant (nonbiological), insertion of, for contour reconstruction of pathological deformity, other than a service associated with a service to which item 52624 applies (Anaes.) (Assist.)

488.55

52324

Direct flap repair, using tongue, first stage (Anaes.) (Assist.)

488.55

52327

Direct flap repair, using tongue, second stage (Anaes.)

242.40

52330

Palatal defect (oronasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (Anaes.) (Assist.)

806.35

52333

Cleft palate, primary repair (Anaes.) (Assist.)

806.35

52336

Cleft palate, secondary repair, closure of fistula using local flaps (Anaes.) (Assist.)

504.00

52337

Alveolar cleft (congenital) unilateral, grafting of, including plastic closure of associated oronasal fistulae and ridge augmentation (Anaes.) (Assist.)

1,102.50

52339

Cleft palate, secondary repair, lengthening procedure (Anaes.) (Assist.)

574.00

52342

Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

997.00

52345

Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.) (Assist.)

1,124.40

52348

Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

1,270.55

52351

Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.) (Assist.)

1,426.90

52354

Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the one jaw, including transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

1,446.55

52357

Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the one jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.) (Assist.)

1,628.50

52360

Mandible and maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw including transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

1,661.40

52363

Mandible and maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.) (Assist.)

1,869.00

52366

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of one jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

1,827.65

52369

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of one jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.)) (Assist.)

2,054.95

52372

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)

1,993.95

52375

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H) (Anaes.) (Assist.)

2,233.40

52378

Genioplasty including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

772.05

52379

Face, contour reconstruction of one region, using autogenous bone or cartilage graft (Anaes.) (Assist.)

1,319.40

52380

Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (MalarMaxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

2,246.65

52382

Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (MalarMaxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

2,693.20

52420

Mandible, fixation by intermaxillary wiring, excluding wiring for obesity

248.65

52424

Dermis, dermofat or fascia graft (excluding transfer of fat by injection) in the oral and maxillofacial region (Anaes.) (Assist.)

488.45

52430

Microvascular repair of the oral and maxillofacial region using microsurgical techniques, with restoration of continuity of artery or vein of distal extremity or digit (Anaes.) (Assist.)

1,124.40

52440

Cleft lip, unilateral—primary repair, one stage, without anterior palate repair (Anaes.) (Assist.)

558.25

52442

Cleft lip, unilateral—primary repair, one stage, with anterior palate repair (Anaes.) (Assist.)

697.95

52444

Cleft lip, bilateral—primary repair, one stage, without anterior palate repair (Anaes.) (Assist.)

775.35

52446

Cleft lip, bilateral—primary repair, one stage, with anterior palate repair (Anaes.) (Assist.)

915.25

52450

Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)

310.15

52452

Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes.) (Assist.)

504.00

52456

Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)

853.15

52458

Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)

310.15

52460

Velopharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (Anaes.)

806.35

52480

Composite graft (chondrocutaneous or chondromucosal) to nose, ear or eyelid (Anaes.) (Assist.)

517.95

52482

Macrocheilia or macroglossia, operation for (Anaes.) (Assist.)

498.35

52484

Macrostomia, operation for (Anaes.) (Assist.)

593.25

 

Division 6.6Group O5: Preprosthetic

6.6.1  Items in Group O5

  This clause sets out items in Group O5.

 

Group O5—Preprosthetic

Column 1

Item

Column 2

Description

Column 3

Fee ($)

52600

Mandibular or palatal exostosis, excision of (Anaes.) (Assist.)

348.90

52603

Mylohyoid ridge, reduction of (Anaes.) (Assist.)

333.50

52606

Maxillary tuberosity, reduction of (Anaes.)

254.40

52609

Papillary hyperplasia of the palate, removal of—less than 5 lesions (Anaes.) (Assist.)

333.50

52612

Papillary hyperplasia of the palate, removal of—5 to 20 lesions (Anaes.) (Assist.)

418.75

52615

Papillary hyperplasia of the palate, removal of—more than 20 lesions (Anaes.) (Assist.)

519.60

52618

Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed—unilateral or bilateral (Anaes.) (Assist.)

604.85

52621

Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed—unilateral (Anaes.) (Assist.)

604.85

52624

Alveolar ridge augmentation with bone or alloplast or both—unilateral (Anaes.) (Assist.)

488.45

52626

Alveolar ridge augmentation—unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes.) (Assist.)

299.60

52627

Osseointegration procedure—extra oral implantation of titanium fixture (Anaes.) (Assist.)

519.60

52630

Osseointegration procedure—fixation of transcutaneous abutment (Anaes.)

192.35

52633

Osseointegration procedure—intraoral implantation of titanium fixture to facilitate restoration of the dentition following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)

519.60

52636

Osseointegration procedure—fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)

192.35

 

Division 6.7Group O6: Neurosurgical

6.7.1  Items in Group O6

  This clause sets out items in Group O6.

 

Group O6—Neurosurgical

Column 1

Item

Column 2

Description

Column 3

Fee ($)

52800

Neurolysis by open operation, without transposition, other than a service associated with a service to which item 52803 applies (Anaes.) (Assist.)

285.45

52803

Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (Anaes.) (Assist.)

411.00

52806

Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (Anaes.) (Assist.)

285.45

52809

Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (Anaes.) (Assist.)

488.55

52812

Nerve trunk, primary repair of, using microsurgical techniques (Anaes.) (Assist.)

697.95

52815

Nerve trunk, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)

736.70

52818

Nerve, transposition of (Anaes.) (Assist.)

488.55

52821

Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes.) (Assist.)

1,062.40

52824

Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (Anaes.) (Assist.)

457.55

52826

Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes.)

245.00

52828

Cutaneous nerve, primary repair of, using microsurgical techniques (Anaes.) (Assist.)

364.40

52830

Cutaneous nerve, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)

480.65

52832

Cutaneous nerve, nerve graft to, using microsurgical techniques (Anaes.) (Assist.)

659.20

 

Division 6.8Group O7: Ear, nose and throat

6.8.1  Items in Group O7

  This clause sets out items in Group O7.

 

Group O7—Ear, nose and throat

Column 1

Item

Column 2

Description

Column 3

Fee ($)

53000

Maxillary antrum, proof puncture and lavage of (Anaes.)

33.55

53003

Maxillary antrum, proof puncture and lavage of, under general anaesthesia, other than a service associated with a service to which another item in Groups O3 to O9 applies (H) (Anaes.)

94.75

53004

Maxillary antrum, lavage of—each attendance at which the procedure is performed, including any associated consultation (Anaes.)

36.70

53006

Antrostomy (radical) (Anaes.) (Assist.)

537.55

53009

Antrum, intranasal operation on or removal of foreign body from (Anaes.) (Assist.)

304.95

53012

Antrum, drainage of, through tooth socket (Anaes.)

121.25

53015

Oroantral fistula, plastic closure of (Anaes.) (Assist.)

605.95

53016

Nasal septum, septoplasty, submucous resection or closure of septal perforation (Anaes.) (Assist.)

498.35

53017

Nasal septum, reconstruction of (Anaes.) (Assist.)

621.70

53019

Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes.) (Assist.)

599.05

53052

Postnasal space, direct examination of, with or without biopsy (Anaes.)

126.65

53054

Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx—one or more of these procedures (Anaes.)

126.65

53056

Examination of nasal cavity or postnasal space, or nasal cavity and postnasal space, under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)

74.20

53058

Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding aftercare) (Anaes.)

126.65

53060

Cauterisation (other than by chemical means) or cauterisation by chemical means when performed under general anaesthesia or diathermy of septum or turbinates for obstruction or haemorrhage secondary to surgery (or trauma)—one or more of these procedures (including any consultation on the same occasion) other than a service associated with another operation on the nose (Anaes.)

103.65

53062

Postsurgical nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)

92.80

53064

Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes.)

168.05

53068

Turbinectomy or turbinectomies, partial or total, unilateral (Anaes.)

140.80

53070

Turbinates, submucous resection of, unilateral (Anaes.)

183.60

 

Division 6.9Group O8: Temporomandibular joint

6.9.1  Items in Group O8

  This clause sets out items in Group O8.

 

Group O8—Temporomandibular joint

Column 1

Item

Column 2

Description

Column 3

Fee ($)

53200

Mandible, treatment of a dislocation of, not requiring open reduction (Anaes.)

72.90

53203

Mandible, treatment of a dislocation of, requiring open reduction (Anaes.)

122.40

53206

Temporomandibular joint, manipulation of, performed in the operating theatre of a hospital, other than a service associated with a service to which another item in Groups O3 to O9 applies (H) (Anaes.)

147.45

53209

Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (Anaes.) (Assist.)

1,700.65

53212

Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)

918.70

53215

Temporomandibular joint, arthroscopy of, with or without biopsy, other than a service associated with another arthroscopic procedure of that joint (Anaes.) (Assist.)

421.50

53218

Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions—one or more of such procedures (Anaes.) (Assist.)

674.20

53220

Temporomandibular joint, arthrotomy of, other than a service to which another item in this Group applies (Anaes.) (Assist.)

339.85

53221

Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)

899.55

53224

Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)

997.20

53225

Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space (Anaes.) (Assist.)

299.60

53226

Temporomandibular joint, synovectomy of, other than a service to which another item in this Group applies (Anaes.) (Assist.)

322.05

53227

Temporomandibular joint, open surgical exploration of, with or without meniscus or capsular surgery, including meniscectomy when performed, with or without microsurgical techniques (Anaes.) (Assist.)

1,225.30

53230

Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)

1,380.25

53233

Temporomandibular joint, surgery of, involving procedures to which item 53224, 53226, 53227 or 53230 applies and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (Anaes.) (Assist.)

1,551.00

53236

Temporomandibular joint, stabilisation of, involving one or more of: repair of capsule, repair of ligament or internal fixation, other than a service to which another item in this Group applies (Anaes.) (Assist.)

485.40

53239

Temporomandibular joint, arthrodesis of, other than a service to which another item in this Group applies (Anaes.) (Assist.)

485.40

53242

Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)

322.05

 

Division 6.10Group O9: Treatment of fractures

6.10.1  Items in Group O9

  This clause sets out items in Group O9.

 

Group O9—Treatment of fractures

Column 1

Item

Column 2

Description

Column 3

Fee ($)

53400

Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting

133.20

53403

Mandible, treatment of fracture of, not requiring splinting

162.80

53406

Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)

419.35

53409

Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)

419.35

53410

Zygomatic bone, treatment of fracture of, not requiring surgical reduction

88.30

53411

Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intraoral or other approach (Anaes.)

246.25

53412

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at one site (Anaes.) (Assist.)

404.35

53413

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.)

495.35

53414

Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.)

569.10

53415

Maxilla, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)

449.25

53416

Mandible, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)

449.25

53418

Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)

584.05

53419

Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)

584.05

53422

Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.)

741.20

53423

Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.)

741.20

53424

Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.)

635.90

53425

Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.)

635.90

53427

Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate (Anaes.) (Assist.)

868.60

53429

Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate (Anaes.) (Assist.)

868.60

53439

Mandible, treatment of a closed fracture of, involving a joint surface (Anaes.)

246.25

53453

Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes.) (Assist.)

498.35

53455

Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.)

585.40

53458

Nasal bones, treatment of fracture of, other than a service to which item 53459 or 53460 applies

44.40

53459

Nasal bones, treatment of fracture of, by reduction (Anaes.)

242.85

53460

Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes.) (Assist.)

495.35

 

Division 6.11Group O11: Regional or field nerve blocks

6.11.1  Items in Group O11

  This clause sets out items in Group O11.

 

Group O11—Regional or field nerve blocks

Column 1

Item

Column 2

Description

Column 3

Fee ($)

53700

Trigeminal nerve, primary division of, injection of an anaesthetic agent

128.75

53702

Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent

64.45

53704

Facial nerve, injection of an anaesthetic agent

38.80

53706

Nerve branch in the oral and maxillofacial region, destruction by a neurolytic agent, other than a service to which another item in this Group applies

128.75

 

Part 7Dictionary

Note: All references in this Part to a provision are references to a provision in this Schedule, unless otherwise indicated.

 

7.1.1  Dictionary

  In this Schedule:

2013 estimated resident population means the preliminary estimated resident population as at 30 June 2013, as published by the Australian Bureau of Statistics.

Aboriginal and Torres Strait Islander health practitioner means a person:

 (a) who is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner; and

 (b) who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.

Aboriginal health worker means a person:

 (a) who holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualification; and

 (b) who is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.

Act means the Health Insurance Act 1973.

afterhours period means any of the following:

 (a) a public holiday;

 (b) a Sunday;

 (c) before 8 am, or after 12 noon, on a Saturday;

 (d) before 8 am, or after 6 pm, on any day other than a Saturday, Sunday or public holiday.

afterhours rural area has the meaning given by clause 2.16.4.

amount under clause 2.1.1 has the meaning given by clause 2.1.1.

amount under clause 2.18.3 has the meaning given by clause 2.18.3.

amount under clause 2.20.2 has the meaning given by clause 2.20.2.

amount under clause 5.3.1 has the meaning given by clause 5.3.1.

amount under clause 5.7.1 has the meaning given by clause 5.7.1.

amount under clause 5.9.1 has the meaning given by clause 5.9.1.

amount under clause 5.9.2 has the meaning given by clause 5.9.2.

amount under clause 5.10.1 has the meaning given by clause 5.10.1.

amount under clause 5.10.2 has the meaning given by clause 5.10.2.

amount under clause 5.10.20 has the meaning given by clause 5.10.20.

amount under clause 5.11.1 has the meaning given by clause 5.11.1.

amount under clause 5.11.2 has the meaning given by clause 5.11.2.

amount under clause 5.11.3 has the meaning given by clause 5.11.3.

amount under clause 6.3.1 has the meaning given by clause 6.3.1.

approved site, for radiation oncology, means a site at which radiation oncology may be performed lawfully under the law of the State or Territory in which the site is located.

ASGC has the meaning given by clause 3.2.1.

ASGS means the July 2016 edition of the Australian Statistical Geography Standard, published by the Australian Bureau of Statistics, as existing on 1 July 2020.

Note: The ASGS could in 2020 be viewed on the Australian Bureau of Statistics’ website (https://www.abs.gov.au).

associated general practitioner:

 (a) for item 732—has the meaning given by clause 2.16.2; and

 (b) for item 2712—has the meaning given by clause 2.20.5.

Australian Type 2 Diabetes Risk Assessment Tool means the Australian Type 2 Diabetes Risk Assessment Tool, developed by the Baker Heart and Diabetes Institute, as existing on 1 July 2020.

Note: The Australian Type 2 Diabetes Risk Assessment Tool could in 2020 be viewed on the Department’s website (http://www.health.gov.au).

birth, in items 16515, 16519, 16522, 16527, 16528, 16590, 20855, 20946, 20958, 51306 and 51309, includes the following:

 (a) induction of labour by surgical or intravenous infusion methods;

 (b) forceps or vacuum extraction;

 (c) caesarean section;

 (d) breech birth;

 (e) management of multiple births;

 (f) episiotomy;

 (g) repair of tears;

 (h) evacuation of the products of conception by manual removal.

brachytherapy treatment verification means a quality assurance procedure:

 (a) that is designed to facilitate accurate and reproducible delivery of brachytherapy to a site or region of the body as specified in a treatment prescription or in a dose plan generated from a treatment prescription; and

 (b) that utilises the capture and assessment of appropriate images using any of the following:

 (i) xrays;

 (ii) computed tomography;

 (iii) ultrasound, if the ultrasound equipment is capable of producing images in 3 dimensions; and

 (c) that includes making a record of the assessment and correcting any significant treatment delivery inaccuracies detected.

bulkbilled, for Division 3.2, has the meaning given by clause 3.2.1.

care recipient means a person to whom residential care (as defined in section 413 of the Aged Care Act 1997) is provided.

case conference team, for item 880, has the meaning given by clause 2.16.18.

cervical screening service means a service to which item 73070, 73071, 73072, 73073, 73074, 73075 or 73076 of the pathology services table applies.

cervical smear service means a service to which former item 73053, 73055, 73057 or 73069 of the pathology services table applied.

closed reduction means treatment of a dislocation or fracture by nonoperative reduction, including the use of percutaneous fixation, or external splintage by cast or splints.

community case conference means a case conference for community based patients.

completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus has the meaning given by clause 2.19.1.

completes the minimum requirements of the Asthma Cycle of Care has the meaning given by clause 2.19.2.

comprehensive hyperbaric medicine facility has the meaning given by clause 5.2.1.

concessional beneficiary has the meaning given by clause 3.2.1.

contribute to a multidisciplinary care plan, for items 729 and 731, has the meaning given by clause 2.16.3.

coordinating, for item 880, has the meaning given by clause 2.16.17.

coordinating a review of team care arrangements, for item 732, has the meaning given by clause 2.16.5.

coordinating the development of team care arrangements, for item 723, has the meaning given by clause 2.16.4.

designated area has the meaning given by clause 3.2.1.

ECG means electrocardiogram.

EEG means electroencephalogram.

eligible allied health provider means any of the following:

 (a) an audiologist;

 (b) an occupational therapist;

 (c) an optometrist;

 (d) an orthoptist;

 (e) a physiotherapist;

 (f) a psychologist;

 (g) a speech pathologist.

eligible disability has the meaning given by clause 2.6.1.

eligible nonvocationally recognised medical practitioner has the meaning given by clause 1.1.2.

eligible stroke centre has the meaning given by clause 5.10.15.

embryology laboratory services has the meaning given by clause 5.2.2.

EMG means electromyogram.

EOG means electrooculogram.

focussed psychological strategies has the meaning given by clause 2.20.1.

foreign body, for items 35360 and 35363, has the meaning given by clause 5.10.10.

general intensive care unit means an area within a hospital that:

 (a) is equipped and staffed so that it is capable of providing to a patient:

 (i) mechanical ventilation for a period of several days; and

 (ii) invasive cardiovascular monitoring; and

 (b) is supported by:

 (i) during normal working hours—at least one specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and

 (ii) at all times—at least one registered medical practitioner who is present in the hospital and immediately available to that area; and

 (iii) at least 18 hours each day—at least one registered nurse; and

 (c) has admission and discharge policies in operation.

general practice means a business, consisting of one or more medical practitioners, that provides a general practice of medical services.

general practitioner has a meaning affected by clause 1.1.3.

GP management plan, for item 10997, has the meaning given by clause 3.1.1.

gravely ill patient lacking current goals of care means a patient to whom all of the following apply:

 (a) the patient either:

 (i) is suffering a lifethreatening acute illness or injury; or

 (ii) is suffering acute illness or injury and, apart from the illness or injury, has a high risk of dying within 12 months;

 (b) one or more alternatives to management of the illness or injury are clinically appropriate for the patient;

 (c) either:

 (i) there is not a record of goals of care for the patient that can readily be retrieved by providers of health care for the patient and that identifies interventions that should, or should not, be made in care of the patient; or

 (ii) there is such a record but it is reasonable to expect that, due to changes in the patient’s condition, the goals recorded will change substantially.

Group A1 disqualified general practitioner means a general practitioner:

 (a) who is partly disqualified under an agreement that is in effect under section 92 of the Act in respect of a service to which an item in Group A1 applies; or

 (b) in relation to whom a final determination under section 106TA of the Act containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified is in effect in respect of a service to which an item in Group A1 applies.

(H) has the meaning given by clause 1.1.7.

immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.

intensive care unit means a general intensive care unit or a neonatal intensive care unit.

living in a community setting, for item 900, has the meaning given by clause 2.17.1.

maxilla:

 (a) for items 45720 to 45752—has the meaning given by clause 5.10.22; and

 (b) for items 52342 to 52375—has the meaning given by clause 6.5.1.

mental disorder has the meaning given by clause 2.20.1.

minor attendance, for an attendance on a patient by a consultant physician, means an attendance that:

 (a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and

 (b) does not result in a substantial alteration to the treatment of the patient.

Modified Monash 2 area means a Statistical Area Level 1 under the ASGS that:

 (a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

 (b) satisfies any of the following criteria:

 (i) the area is in an Urban Centre and Locality with a 2013 estimated resident population of more than 50,000;

 (ii) the area is in an Urban Centre and Locality, the geographic centre of which is no more than 20 km road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of more than 50,000;

 (iii) the area is not in an Urban Centre and Locality, but the geographic centre of the area is no more than 20 km road distance from the boundary of an Urban Centre and Locality with a 2013 estimated resident population of more than 50,000; and

 (c) is not a Modified Monash 7 area.

Modified Monash 3 area means a Statistical Area Level 1 under the ASGS that:

 (a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

 (b) satisfies any of the following criteria:

 (i) the area is in an Urban Centre and Locality with a 2013 estimated resident population of more than 15,000 but no more than 50,000;

 (ii) the area is in an Urban Centre and Locality, the geographic centre of which is no more than 15 km road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of more than 15,000 but no more than 50,000;

 (iii) the area is not in an Urban Centre and Locality, but the geographic centre of the area is no more than 15 km road distance from the boundary of an Urban Centre and Locality with a 2013 estimated resident population of more than 15,000 but no more than 50,000; and

 (c) is not a Modified Monash 2 area or Modified Monash 7 area.

Modified Monash 4 area means a Statistical Area Level 1 under the ASGS that:

 (a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

 (b) satisfies any of the following criteria:

 (i) the area is in an Urban Centre and Locality with a 2013 estimated resident population of at least 5,000 but no more than 15,000;

 (ii) the area is in an Urban Centre and Locality, the geographic centre of which is no more than 10 km road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of at least 5,000 but no more than 15,000;

 (iii) the area is not in an Urban Centre and Locality, but the geographic centre of the area is no more than 10 km road distance from the boundary of an Urban Centre and Locality with a 2013 estimated resident population of at least 5,000 but no more than 15,000; and

 (c) is not a Modified Monash 2 area, Modified Monash 3 area or Modified Monash 7 area.

Modified Monash 5 area means a Statistical Area Level 1 under the ASGS that:

 (a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

 (b) is not a Modified Monash 2 area, Modified Monash 3 area, Modified Monash 4 area or Modified Monash 7 area.

Modified Monash 6 area means a Statistical Area Level 1 under the ASGS that:

 (a) is categorised under the ASGS as RA 3 (Remote Australia); and

 (b) is not a Modified Monash 7 area.

Modified Monash 7 area means a Statistical Area Level 1 under the ASGS that:

 (a) is entirely located on an island or islands more than 5 km from the Australian mainland or Tasmania, as measured between coastlines at the low water mark; or

 (b) is located on Magnetic Island; or

 (c) is categorised under the ASGS as RA 4 (Very Remote Australia).

motion segment has the meaning given by clause 5.10.29.

multidisciplinary care plan:

 (a) for items 729 and 731—has the meaning given by clause 2.16.6; and

 (b) for item 10997—has the meaning given by clause 3.1.1.

multidisciplinary case conference has the meaning given by clause 1.1.4.

multidisciplinary case conference team has the meaning given by clause 1.1.5.

multidisciplinary discharge case conference, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.16.14.

neonatal intensive care unit means a separate hospital area that:

 (a) is equipped and staffed so that it is capable of providing to a patient who is a newly born child:

 (i) mechanical ventilation for a period of several days; and

 (ii) invasive cardiovascular monitoring; and

 (b) is supported by:

 (i) during normal working hours—at least one consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and

 (ii) at all times—at least one registered medical practitioner who is present in the hospital and immediately available to that area; and

 (iii) at least 18 hours each day—at least one registered nurse; and

 (c) has admission and discharge policies in operation.

nondirective pregnancy support counselling, for item 4001, has the meaning given by clause 2.22.1.

nonmedicare service means any of the following:

 (a) endoluminal gastroplication, for the treatment of gastrooesophageal reflux disease;

 (b) gamma knife surgery;

 (c) intradiscal electro thermal arthroplasty;

 (d) intravascular ultrasound, except if used in conjunction with intravascular brachytherapy;

 (e) introarticular viscosupplementation, for the treatment of osteoarthritis of the knee;

 (f) low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator;

 (g) lung volume reduction surgery, for advanced emphysema;

 (h) photodynamic therapy, for skin and mucosal cancer;

 (i) placement of artificial bowel sphincters, in the management of faecal incontinence;

 (j) selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer;

 (k) specific mass measurement of bone alkaline phosphatise;

 (l) transmyocardial laser revascularisation;

 (m) vertebral axial decompression therapy, for chronic back pain;

 (n) autologous chondrocyte implantation and matrixinduced autologous chondrocyte implantation;

 (o) vertebroplasty;

 (p) extracorporeal magnetic innervation.

NOSE Scale has the meaning given by clause 5.10.21.

open reduction means treatment of a dislocation or fracture by either:

 (a) operative exposure, including the use of any internal or external fixation; or

 (b) nonoperative (closed) reduction using intramedullary fixation or external fixation.

organise and coordinate:

 (a) for items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866—has the meaning given by clause 2.16.15; and

 (b) for items mentioned in Subgroups 2 and 4 of Group A24—has the meaning given by clause 2.21.1; and

 (c) for items 6029 to 6042—has the meaning given by clause 2.27.1; and

 (d) for items 6064 to 6075—has the meaning given by clause 2.28.1.

outcome measurement tool has the meaning given by clause 2.20.1.

participate:

 (a) for items 747, 750, 758, 825, 826, 828, 835, 837 and 838—has the meaning given by clause 2.16.16; and

 (b) for items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088 and 3093—has the meaning given by clause 2.21.2; and

 (c) for items 6035 to 6042—has the meaning given by clause 2.27.2; and

 (d) for items 6071 to 6075—has the meaning given by clause 2.28.2.

participating in a video conferencing consultation: a medical practitioner is participating in a video conferencing consultation if:

 (a) the medical practitioner attends a patient who is receiving a service under an item in this Schedule from a specialist or consultant physician; and

 (b) the specialist or consultant physician is providing the service:

 (i) in relation to the specialist’s or consultant physician’s speciality to the patient; and

 (ii) by way of a video conferencing consultation.

patient’s medical condition requires urgent assessment has the meaning given by clause 2.14.1.

patient’s usual general practitioner means a general practitioner:

 (a) who has provided the majority of services to the patient in the past 12 months; or

 (b) who is likely to provide the majority of services to the patient in the following 12 months; or

 (c) located at a medical practice that:

 (i) has provided the majority of services to the patient in the past 12 months; or

 (ii) is likely to provide the majority of services to the patient in the next 12 months.

person with a chronic disease, for item 10997, has the meaning given by clause 3.1.1.

pharmaceutical benefits scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.

practice location, for the provision of a medical service, means the place of practice in relation to which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Chief Executive Medicare.

practice midwife has the meaning given by clause 5.5.2.

practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the Act applies.

preparation of a GP mental health treatment plan has the meaning given by clause 2.20.3.

preparation of goals of care for a patient, by a medical practitioner, means the carrying out of all of the following activities by the practitioner:

 (a) comprehensively evaluating the patient’s medical, physical, psychological and social issues;

 (b) identifying major issues that require goals of care for the patient to be set;

 (c) assessing the patient’s capacity to make decisions about goals of care for the patient;

 (d) discussing care of the patient with the patient, or a person (the surrogate) who can make decisions on the patient’s behalf about care for the patient, and as appropriate with any of the following:

 (i) members of the patient’s family;

 (ii) other persons who provide care for the patient;

 (iii) other health practitioners;

 (e) offering in that discussion reasonable options for care of the patient, including alternatives to intensive or escalated care;

 (f) agreeing with the patient or the surrogate on goals of care for the patient that address all major issues identified;

 (g) recording the agreed goals so that:

 (i) the record can be readily retrieved by other providers of health care for the patient; and

 (ii) interventions that should, or should not, be made in care of the patient are identified.

preparing a GP management plan, for item 721, has the meaning given by clause 2.16.7.

qualified adult sleep medicine practitioner has the meaning given by clause 4.1.2.

qualified medical acupuncturist has the meaning given by clause 2.10.1.

qualified paediatric sleep medicine practitioner has the meaning given by clause 4.1.2.

qualified sleep medicine practitioner has the meaning given by clause 4.1.2.

RACP Advisory Committee has the meaning given by clause 4.1.2.

RACP Appeal Committee has the meaning given by clause 4.1.2.

RACP Credentialling Subcommittee has the meaning given by clause 4.1.2.

radiation oncology treatment verification means a quality assurance procedure:

 (a) that is designed to facilitate accurate and reproducible delivery of radiation therapy to a site or region of the body as specified in a treatment prescription or a dose plan generated from a treatment prescription; and

 (b) that utilises the capture and assessment of appropriate images using any of the following:

 (i) xrays;

 (ii) computed tomography;

 (iii) ultrasound, if the ultrasound equipment is capable of producing images in 3 dimensions; and

 (c) that includes making a record of the assessment and correcting any significant treatment delivery inaccuracies detected.

recognised emergency department of a private hospital means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.

referring practitioner, in relation to a referral, means the person making the referral.

Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

regional, rural or remote area means either of the following:

 (a) an area classified as RRMAs 37 under the Rural, Remote and Metropolitan Areas Classification;

 (b) Norfolk Island.

registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989, as existing on 1 July 2020.

report, for Division 4.1, has the meaning given by clause 4.1.1.

residential aged care facility means a facility where residential care (as defined in section 413 of the Aged Care Act 1997) is provided.

residential medication management review, for item 903, has the meaning given by clause 2.17.2.

reviewing a GP management plan, for item 732, has the meaning given by clause 2.16.8.

review of a GP mental health treatment plan has the meaning given by clause 2.20.4.

risk assessment:

 (a) for items 135, 137 and 139—has the meaning given by clause 2.6.2; and

 (b) for item 289—has the meaning given by clause 2.11.4.

Rural, Remote and Metropolitan Areas Classification means the document so titled, as existing on 1 July 2020, setting out certain categories of areas in Australia that have been determined by the Department by reference to population size and remoteness of locality on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994.

service time has the meaning given by clause 5.9.3.

single course of treatment has the meaning given by clause 1.1.6.

SLA has the meaning given by clause 3.2.1.

SSD has the meaning given by clause 3.2.1.

team care arrangements means a plan under item 723 or 732 (for a review of team care arrangements under item 723).

telehealth eligible area means an area classified as a telehealth eligible area by the Minister, identified as such on the Department’s website on 1 July 2020.

Note: Maps showing telehealth eligible areas could in 2020 be viewed on the Department’s website (http://www.health.gov.au).

treatment cycle, in relation to assisted reproductive services, has the meaning given by clause 5.2.3.

unreferred service has the meaning given by clause 3.2.1.

unsociable hours means the period starting at 11 pm on a day and ending at 7 am on the next day.

Urban Centre and Locality means an area defined as an Urban Centre and Locality under the ASGS.

 

Schedule 2Repeals

 

Health Insurance (General Medical Services Table) Regulations (No. 1) 2020

1  The whole of the instrument

Repeal the instrument.

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

 

Endnote 2—Abbreviation key

 

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/subsubparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

SubCh = SubChapter(s)

cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (General Medical Services Table) Regulations (No. 2) 2020

15 June 2020 (F2020L00711)

1 July 2020 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (2020 Measures No. 1) Regulations 2020

6 July 2020 (F2020L00882)

Sch 1 (items 5–17): 1 Aug 2020 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.....................

rep LA s 48D

s 5.....................

rep LA s 48C

Schedule 1

 

Part 1

 

Division 1.2

 

c 1.2.6...................

am F2020L00882

c 1.2.7...................

am F2020L00882

c 1.2.11..................

am F2020L00882

Part 4

 

Division 4.1

 

Group D1 Table............

am F2020L00882

Schedule 2

 

Schedule 2................

rep LA s 48C