AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH AND AGED CARE
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Urgent Care Clinic Program – New South Wales Urgent Care Services) Direction (No. 2) 2024
I, Nigel Murray, Assistant Secretary, Medicare Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Aged Care, acting under subsection 19(2) of the Health Insurance Act 1973 (the Act), hereby:
(2) DIRECT that Medicare Benefits shall be payable in respect of:
(a) A professional service (as defined in section 3 of the Act) which has been agreed to be provided:
(i) between the Commonwealth (represented by the Department of Health and Aged Care, ABN: 83 605 426 759) and the State of New South Wales (represented by the New South Wales Department of Health, ABN: 92 697 899 630) by New South Wales Urgent Care Services that has been assessed as meeting the requirements of the Commonwealth Urgent Care Clinic program; and
(ii) for which items specified in Schedules A, B and C of this Direction and of the general medical services table (means the table prescribed under subsection 4(1) of the Act) and pathology service table (means the table prescribed under section 4A of the Act) relates; and
(b) Where the professional service is provided to:
(i) an eligible person (as defined in section 3 of the Act);
(ii) a patient who is not receiving the service as part of an episode of hospital treatment (as defined in section 121-5 of the Private Health Insurance Act 2007); and
(iii) a patient who also is not receiving a service which attracts a payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient; and
(c) The professional services referred to in paragraph (2)(a) must be provided:
(i) if the service is specified in Schedule A:
(A) at a practice location specified in Schedule D or E of this Direction; and
(B) by a general practitioner, prescribed medical practitioner or participating nurse practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
(ii) if the service is specified in Schedule B:
(A) at a practice location specified in Schedule D of this Direction; and
(B) by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
(iii) if the service is specified in Schedule C:
(A) at a practice location specified in Schedule E of this Direction; and
(B) by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
DECLARE that this Direction commences on 29 June 2024 and ceases to have effect at the end of 30 June 2025 unless earlier revoked.
Date this 17 day of June 2024
Nigel Murray
Assistant Secretary
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health and Aged Care
MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the Urgent care clinic program
For services listed in the below tables, all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
General practitioner attendances to which no other item applies | 3, 23, 36, 44, 123 | |||
A5 | Prolonged attendances to which no other item applies | |||
A7 | Acupuncture and non-specialist practitioner items | 9 | Prescribed medical practitioner mental health care | 279 |
A20 | Mental health care | 1 | GP mental health treatment plans | 2713 |
A22 | General practitioner after-hours attendances to which no other item applies | 5000, 5020, 5040, 5060, 5071 | ||
Miscellaneous diagnostic procedures and investigations | 6 | Cardiovascular | 11707 | |
T4 | Obstetrics | 16500 | ||
T7 | Regional or field nerve blocks | 18213 | ||
T8 | Surgical operations | 1 | General | 30003, 30006, 30026, 30029, 30032, 30035, 30038, 30042, 30045, 30049, 30061, 30064, 30099, 30216, 30219 |
2 | Colorectal | 32147 | ||
5 | Urological | 36800 | ||
8 | Ear, nose and throat | 41500, 41659, 41677 | ||
9 | Ophthalmology | 42644, 42650 | ||
14 | Hand or wrist surgery | 46513, 46528, 46531 | ||
15 | Orthopaedic | 47904, 47915, 47916, 47015, 47030, 47042, 47057, 47063, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466, 47471, 47543, 47561, 47579, 47595, 47637, 47663, 47735 | ||
Management of bulk-billed services | 1 | Management of general bulk-billed services | 10990, 10991, 10992, 75855, 75856, 75857, 75858 | |
2 | General support service | 75870, 75871, 75872, 75873, 75874, 75875, 75876 | ||
M14 | Nurse practitioners | 1 | Nurse practitioners | 82200, 82205, 82210, 82215 |
*Note: Claims under any item in Group A7 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.
Group | Group Name | Item Number |
P9 | simple basic pathology tests | 73806 |
SCHEDULE B
MEDICARE BENEFITS SCHEDULE ITEMS WHERE A CLINIC IS LOCATED IN MMM 1 LOCATIONS
For services listed in the below tables, all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
Other non-referred attendances to which no other item applies | 1 | Other medical practitioner attendances | 52, 53, 54, 57 | |
Other non-referred after-hours attendances to which no other item applies | 5200, 5203, 5207, 5208 |
*Note: Claims under any item in Group A2 and A23 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.
SCHEDULE C
MEDICARE BENEFITS SCHEDULE ITEMS WHERE A CLINIC IS LOCATED IN MMM 2-7 LOCATIONS
For services listed in the below tables, all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
A7 | Acupuncture and non-specialist practitioner items | 2 | Prescribed medical practitioner attendance to which no other item applies | 179, 185, 189, 203 |
10 | Prescribed Medical Practitioner after‑hours attendances to which no other item applies | 733, 737, 741, 745 |
*Note: Claims under any item in Group A7 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.
APPROVED MMM 1 PRACTICE LOCATIONS AS AGREED UNDER THE URGENT CARE SERVICES AGREEMENT BETWEEN THE COMMONWEALTH AND THE STATE OF NEW SOUTH WALES
Approved primary care locations:
State | MMM 1 Location | Practice Name | Legal Name | Street Address |
NSW | Auburn | NAS Advance Medical Centre Auburn | NOUSSAIR & NOSIR PTY LTD & R & C MESSIHA PTY LTD | 79 Auburn Road |
NSW | Caringbah | Caringbah Medical and Dental Centre | Idameneo (No. 123) Pty Ltd as the Trustee for Artlu Unit Trust | 42 President Avenue, Caringbah NSW 2229 |
NSW | Castle Hill | Health Zone Barwell Medical Centre | Health Zone Pty Ltd | 16, 7-9 Barwell Avenue |
NSW | Gregory Hills | My Family Health Medical Centre | Ak & Ds Pty Ltd Atf Ak & Ds Unit Trust | Unit 2, 3 Rodeo Road, Gregory Hills NSW 2557 |
NSW | Marsden Park | Our Medical Home Marsden Park | Wycombe Services Pty Ltd | 1/9 Hollinsworth Road |
NSW | Rouse Hill | Rouse Hill Family Medical Practice | DEPAMA PTY LTD | 4-7 Commercial Road |
APPROVED MMM 2-7 PRACTICE LOCATIONS AS AGREED UNDER THE URGENT CARE SERVICES AGREEMENT BETWEEN THE COMMONWEALTH AND THE STATE OF NEW SOUTH WALES
Approved primary care locations:
State | MMM 3 Location | Practice Name | Legal Name | Street Address |
NSW | Armidale | UNE Medical Practice | UNE Life Pty Ltd | 110 Butler Street, Armidale NSW 2350 |
NSW | Goulburn | Marima Medical Clinic | Medical Seventh Group Pty Ltd | 152 Auburn St Goulburn, NSW 2580 |
NSW | Orange | Bloomfield Medical Group | The Trustee for BMG Service Trust | Level 2, 1521 Forest Road, Orange NSW 2800 |