Commonwealth Coat of Arms of Australia

 

Health Insurance Legislation Amendment (HospitalOnly Services and Other Measures) Regulations 2025

I, the Honourable Sam Mostyn AC, GovernorGeneral of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.

Dated    6 February  2025

Sam Mostyn AC

GovernorGeneral

By Her Excellency’s Command

Mark Butler

Minister for Health and Aged Care

 

 

 

 

 

1 Name

2 Commencement

3 Authority

4 Schedules

Schedule 1—Hospitalonly services

Part 1—Items to which “(H)” is to be added after the last word in the item description

Health Insurance (General Medical Services Table) Regulations 2021

Part 2—Items to which “(H)” is to be added on a new line of the item description

Health Insurance (General Medical Services Table) Regulations 2021

Part 3—Items in which “(H)” is to be inserted before “(Anaes.)”

Health Insurance (General Medical Services Table) Regulations 2021

Part 4—Other items

Health Insurance (General Medical Services Table) Regulations 2021

Part 5—Diagnostic Imaging Services Table

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

Schedule 2—Other amendments

Part 1—General medical services table

Division 1—Leftsided intravascular microaxial ventricular assist devices

Health Insurance (General Medical Services Table) Regulations 2021

Division 2—Perioperative continuous nerve blockade

Health Insurance (General Medical Services Table) Regulations 2021

Part 2—Pathology services table

Health Insurance (Pathology Services Table) Regulations 2020

Part 3—Other amendments

Health Insurance Regulations 2018

 

  This instrument is the Health Insurance Legislation Amendment (HospitalOnly Services and Other Measures) Regulations 2025.

 (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 March 2025.

1 March 2025

Note: This table relates only to the provisions of this instrument as originally made.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.

  This instrument is made under the Health Insurance Act 1973.

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

1  Amendments of listed provisions—adding “(H)” after the last word in the item description

Each item (GMST item) of Schedule 1 listed in the following table is amended by adding “(H)” at the end of the cell at column 2 of the item.

 

Item

GMST item

1

11627

2

13030

3

13100

4

13103

5

13300

6

13303

7

13306

8

13309

9

13506

10

13703

11

13706

12

13750

13

13755

14

13830

15

13832

16

13834

17

13835

18

13837

19

13838

20

13840

21

13848

22

16621

23

16624

24

16627

25

18226

26

18227

27

18282

28

20102

29

20104

30

20142

31

20143

32

20144

33

20145

34

20147

35

20162

36

20172

37

20174

38

20176

39

20190

40

20192

41

20210

42

20212

43

20214

44

20216

45

20220

46

20222

47

20225

48

20230

49

20320

50

20321

51

20330

52

20350

53

20352

54

20355

55

20401

56

20402

57

20403

58

20404

59

20405

60

20406

61

20410

62

20450

63

20452

64

20470

65

20472

66

20474

67

20500

68

20522

69

20524

70

20526

71

20528

72

20540

73

20542

74

20546

75

20548

76

20600

77

20604

78

20620

79

20622

80

20632

81

20634

82

20670

83

20680

84

20690

85

20704

86

20706

87

20740

88

20752

89

20754

90

20756

91

20770

92

20791

93

20792

94

20793

95

20794

96

20798

97

20806

98

20810

99

20830

100

20840

101

20841

102

20844

103

20845

104

20846

105

20847

106

20848

107

20850

108

20855

109

20860

110

20862

111

20863

112

20864

113

20866

114

20867

115

20868

116

20880

117

20882

118

20884

119

20902

120

20904

121

20905

122

20906

123

20911

124

20912

125

20914

126

20916

127

20924

128

20926

129

20928

130

20930

131

20932

132

20934

133

20936

134

20938

135

20942

136

20944

137

20954

138

20956

139

20960

140

21116

141

21120

142

21130

143

21140

144

21150

145

21155

146

21160

147

21170

148

21200

149

21202

150

21210

151

21212

152

21214

153

21215

154

21216

155

21220

156

21230

157

21232

158

21234

159

21270

160

21272

161

21274

162

21275

163

21280

164

21340

165

21360

166

21380

167

21382

168

21390

169

21392

170

21400

171

21402

172

21403

173

21404

174

21420

175

21430

176

21432

177

21440

178

21445

179

21464

180

21472

181

21474

182

21480

183

21482

184

21484

185

21486

186

21490

187

21500

188

21502

189

21522

190

21530

191

21532

192

21535

193

21620

194

21622

195

21630

196

21632

197

21634

198

21636

199

21638

200

21650

201

21652

202

21654

203

21656

204

21670

205

21680

206

21682

207

21685

208

21712

209

21714

210

21716

211

21730

212

21732

213

21756

214

21760

215

21772

216

21785

217

21790

218

21820

219

21830

220

21832

221

21834

222

21840

223

21842

224

21860

225

21865

226

21870

227

21872

228

21879

229

21880

230

21881

231

21882

232

21883

233

21884

234

21885

235

21886

236

21887

237

21910

238

21915

239

21916

240

21925

241

21930

242

21936

243

21941

244

21942

245

21943

246

21952

247

22002

248

22007

249

22008

250

22015

251

22020

252

22031

253

22036

254

22041

255

22051

256

22055

257

22060

258

22075

259

23010

260

25000

261

25005

262

25010

263

25013

264

25014

265

25020

266

25025

267

25030

268

25050

269

25200

270

37227

271

45888

272

47477

273

51306

274

51309

275

51312

276

51315

277

51800

278

52420

 

2  Schedule 1 (item 20560, column 2, paragraph (b))

Omit “prosthesis”, substitute:

prosthesis

(H)

3  Schedule 1 (item 20745, column 2, paragraph (e))

Omit “tumour”, substitute:

tumour

(H)

4  Schedule 1 (item 20790, column 2, paragraph (d))

Omit “shunts”, substitute:

shunts

(H)

5  Schedule 1 (item 22012, column 2, paragraph (e))

Omit “pressure”, substitute:

pressure

(H)

6  Schedule 1 (item 22014, column 2, paragraph (e))

Omit “pressure”, substitute:

pressure

(H)

7  Schedule 1 (item 22025, column 2, paragraph (b))

Omit “procedure”, substitute:

procedure

(H)

8  Schedule 1 (item 22065, column 2, paragraph (b))

Omit “applies”, substitute:

applies

(H)

9  Schedule 1 (item 25205, column 2, paragraph (f))

Omit “patients”, substitute:

patients

(H)

10  Schedule 1 (item 51318, column 2, paragraph (c))

Omit “damage”, substitute:

damage

(H)

11  Amendments of listed provisions—inserting “(H)” before “(Anaes.)”

Each item (GMST item) of Schedule 1 listed in the following table is amended by inserting “(H)” before “(Anaes.)” in column 2 of the item.

 

Item

GMST item

1

11801

2

13212

3

13318

4

13319

5

13700

6

13815

7

13818

8

14212

9

16520

10

16564

11

16573

12

18216

13

18219

14

18284

15

18286

16

18288

17

18294

18

18296

19

30024

20

30058

21

30183

22

30229

23

30235

24

30259

25

30269

26

30272

27

30281

28

30286

29

30287

30

30293

31

30412

32

30419

33

30428

34

30430

35

30431

36

30440

37

30450

38

30457

39

30469

40

30475

41

30478

42

30481

43

30484

44

30485

45

30488

46

30490

47

30491

48

30559

49

30563

50

30593

51

30618

52

30631

53

30639

54

30649

55

30663

56

30666

57

30676

58

30679

59

30680

60

30682

61

30684

62

30686

63

30687

64

30688

65

30690

66

30692

67

30694

68

31245

69

31400

70

31406

71

31423

72

31500

73

31503

74

31509

75

31557

76

32075

77

32084

78

32087

79

32095

80

32105

81

32106

82

32123

83

32150

84

32156

85

32165

86

32222

87

32223

88

32224

89

32225

90

32226

91

32227

92

32228

93

32229

94

33100

95

33109

96

33116

97

33119

98

33127

99

33142

100

33166

101

33518

102

33800

103

33806

104

33810

105

33812

106

34106

107

34118

108

34130

109

34154

110

34500

111

34527

112

34528

113

34529

114

34530

115

34533

116

34534

117

34538

118

34540

119

34800

120

34821

121

34830

122

35000

123

35300

124

35303

125

35306

126

35309

127

35319

128

35320

129

35321

130

35330

131

35410

132

35412

133

35500

134

35506

135

35536

136

35612

137

35680

138

36504

139

36507

140

36508

141

36543

142

36546

143

36558

144

36600

145

36604

146

36624

147

36633

148

36663

149

36664

150

36666

151

36803

152

36811

153

36818

154

36821

155

36822

156

36823

157

36824

158

36827

159

36833

160

36836

161

36840

162

36845

163

36860

164

37008

165

37215

166

37224

167

37411

168

37418

169

37604

170

37606

171

37619

172

37806

173

37807

174

37818

175

37819

176

37830

177

37831

178

38200

179

38203

180

38206

181

38209

182

38212

183

38213

184

38241

185

38244

186

38247

187

38248

188

38249

189

38251

190

38252

191

38254

192

38256

193

38270

194

38272

195

38275

196

38287

197

38293

198

38307

199

38308

200

38309

201

38310

202

38311

203

38313

204

38314

205

38316

206

38317

207

38319

208

38320

209

38322

210

38323

211

38416

212

38417

213

38419

214

38420

215

38423

216

38428

217

38829

218

39007

219

39109

220

39121

221

39140

222

39307

223

39319

224

39329

225

39332

226

39339

227

39342

228

39345

229

39815

230

40018

231

40803

232

41603

233

41614

234

41615

235

41650

236

41686

237

41746

238

41810

239

41831

240

41832

241

41876

242

41885

243

41886

244

42506

245

42512

246

42551

247

42563

248

42574

249

42576

250

42596

251

42599

252

42602

253

42605

254

42626

255

42665

256

42672

257

42673

258

42698

259

42701

260

42702

261

42703

262

42704

263

42705

264

42707

265

42710

266

42713

267

42716

268

42719

269

42734

270

42743

271

42761

272

42764

273

42773

274

42854

275

42857

276

42860

277

43530

278

43533

279

44104

280

44105

281

44130

282

44136

283

44334

284

44373

285

44376

286

45018

287

45033

288

45212

289

45227

290

45233

291

45518

292

45545

293

45548

294

45572

295

45575

296

45581

297

45632

298

45635

299

45646

300

45674

301

45692

302

45704

303

45809

304

45811

305

45813

306

45827

307

45849

308

45871

309

45873

310

46113

311

46335

312

46364

313

46401

314

46414

315

46434

316

46493

317

46502

318

46503

319

46504

320

47007

321

47009

322

47027

323

47033

324

47049

325

47053

326

47054

327

47060

328

47351

329

47357

330

47402

331

47414

332

47435

333

47465

334

47468

335

47495

336

47537

337

47540

338

47546

339

47552

340

47559

341

47568

342

47570

343

47612

344

47615

345

47621

346

47630

347

47639

348

47666

349

47678

350

47762

351

47790

352

47791

353

47903

354

47953

355

48900

356

49106

357

49124

358

49213

359

49586

360

49590

361

49803

362

49809

363

50203

364

50224

365

50354

366

50411

367

50414

368

50417

369

50423

370

50544

371

50576

372

50950

373

50952

374

51110

375

51115

376

51902

377

52048

378

52051

379

52054

380

52061

381

52062

382

52066

383

52069

384

52078

385

52092

386

52094

387

52095

388

52098

389

52102

390

52105

391

52114

392

52117

393

52120

394

52122

395

52123

396

52126

397

52129

398

52130

399

52131

400

52138

401

52141

402

52144

403

52147

404

52148

405

52158

406

52182

407

52184

408

52186

409

52303

410

52306

411

52318

412

52319

413

52321

414

52324

415

52327

416

52330

417

52333

418

52336

419

52337

420

52339

421

52378

422

52379

423

52380

424

52382

425

52424

426

52430

427

52440

428

52442

429

52444

430

52446

431

52450

432

52452

433

52456

434

52458

435

52460

436

52480

437

52482

438

52484

439

52603

440

52612

441

52615

442

52626

443

52800

444

52803

445

52809

446

52812

447

52815

448

52818

449

52821

450

52828

451

52830

452

53006

453

53015

454

53016

455

53017

456

53019

457

53056

458

53060

459

53068

460

53070

461

53203

462

53209

463

53212

464

53215

465

53218

466

53220

467

53221

468

53224

469

53225

470

53226

471

53227

472

53230

473

53233

474

53236

475

53239

476

53242

477

53406

478

53409

479

53411

480

53412

481

53413

482

53414

483

53415

484

53416

485

53418

486

53419

487

53422

488

53423

489

53424

490

53425

491

53427

492

53429

493

53453

494

53455

495

53460

12  Schedule 1 (item 16527, column 2)

Omit “(Anaes.)”.

13  Schedule 1 (item 16527, column 2)

After “pregnancy”, insert “(Anaes.)”.

14  Schedule 1 (item 16528, column 2)

Omit “(Anaes.)”.

15  Schedule 1 (item 16528, column 2)

After “pregnancy”, insert “(H) (Anaes.)”.

16  Schedule 1 (item 42504, column 2, paragraph (b))

Omit “Surgery (Anaes.)”, substitute:

Surgery

(H) (Anaes.)

17  Clause 1.2.15 of Schedule 1 (heading)

Omit “and (NR)”, substitute “, (NR) and (H)”.

18  At the end of clause 1.2.15 of Schedule 1

Add:

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

19  Schedule 1 (item 55130, column 2)

Omit “applies (R) (Anaes.)”, substitute:

applies

(R) (H) (Anaes.)

20  Schedule 1 (item 55135, column 2)

Omit “applies (R) (Anaes.)”, substitute:

applies

(R) (H) (Anaes.)

21  Schedule 1 (items 60072, 60075 and 60078, column 2)

After “(NR)”, insert “(H)”.

22  Schedule 1 (item 63499, column 2)

Omit “perform an anaesthetic”, substitute “perform an anaesthetic (H)”.

23  Clause 3.1 of Schedule 1

Insert:

(H) has the meaning given by subclause 1.2.15(3).

24  Amendments of listed provisions—omitting “(R)” and substituting “(R) (H)”

Each item (DIST item) of Schedule 1 listed in the following table is amended by omitting “(R)” and substituting “(R) (H)” in column 2 of the item.

 

Item

DIST item

1

55118

2

59970

3

60000

4

60003

5

60006

6

60009

7

60012

8

60015

9

60018

10

60021

11

60024

12

60027

13

60030

14

60033

15

60036

16

60039

17

60042

18

60045

19

60048

20

60051

21

60054

22

60057

23

60060

24

60063

25

60066

26

60069

27

60500

28

60506

29

60509

30

61109

1  Schedule 1 (item 13851, cell at column 2)

Repeal the cell, substitute:

Ventricular assist device (excluding intravascular microaxial ventricular assist device inserted into the right ventricle), 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 (H)

2  Schedule 1 (item 13854, cell at column 2)

Repeal the cell, substitute:

Ventricular assist device (excluding intravascular microaxial ventricular assist device inserted into the right ventricle), 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 (H)

3  Subclause 5.10.17(2) of Schedule 1

After “38618,”, insert “38619,”.

4  Schedule 1 (after item 38375)

Insert:

38376

Percutaneous insertion of an intravascular microaxial ventricular assist device, into the left ventricle only, by arteriotomy, including all associated intraoperative imaging, if:

(a) the patient has deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; or

(b) the patient:

(i) is on venoarterial extracorporeal membrane oxygenation, for deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; and

(ii) due to the effects of established venoarterial extracorporeal membrane oxygenation, requires unloading of the left ventricle

(H) (Anaes.)

718.00

5  Schedule 1 (after item 38615)

Insert:

38616

Surgical insertion of an intravascular microaxial ventricular assist device, into the left ventricle only, by arteriotomy, including all associated intraoperative imaging, if:

(a) the patient has deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; or

(b) the patient:

(i) is on venoarterial extracorporeal membrane oxygenation, for deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; and

(ii) due to the effects of established venoarterial extracorporeal membrane oxygenation, requires unloading of the left ventricle

(H) (Anaes.)

1077.00

6  Schedule 1 (after item 38618)

Insert:

38619

Surgical removal of a leftsided intravascular microaxial ventricular assist device (H) (Anaes.)

646.00

7  Schedule 1 (item 38621)

After “other than”, insert “a service to which item 38619 applies, or”.

8  Schedule 1 (after item 22031)

Insert:

22032

Introduction of a plexus or nerve block to a peripheral nerve, perioperatively performed using an insitu catheter in association with anaesthesia and surgery, for postoperative pain management

4 base units

9  Schedule 1 (after item 69415)

Insert:

69421

Detection of respiratory pathogen nucleic acid from a nasal swab, throat swab, nasopharyngeal aspirate and/or lower respiratory tract sample

Testing of 4 pathogens

78.25

69422

Detection of respiratory pathogen nucleic acid from a nasal swab, throat swab, nasopharyngeal aspirate and/or lower respiratory tract sample, including a service described in item 69421

Testing of 5 or more pathogens

85.55

10  Schedule 1 (item 73296, column 2, subparagraph (a)(ii))

Omit “STK11, PTEN, CDH1, PALB2 and TP53”, substitute “other relevant”.

11  Schedule 1 (item 73297, column 2, subparagraph (a)(ii))

Omit “STK11, PTEN, CDH1, PALB2 and TP53”, substitute “one or more other relevant genes”.

12  Schedule 1 (item 73297, column 2, subparagraph (b)(i))

Omit “; or”, substitute “; and”.

13  Section 31

Omit “73828” (wherever occurring), substitute “73825”.

14  Section 44 (at the end of the cell at table item 2, column 2)

Add “, 58903”.