Health Insurance (General Medical Services Table) Regulation 2015
Select Legislative Instrument No. 84, 2015
I, General the Honourable Sir Peter Cosgrove AK MC (Ret’d), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulation.
Dated 17 June 2015
Peter Cosgrove
Governor‑General
By His Excellency’s Command
Sussan Ley
Minister for Health
Contents
1............ Name................................................................................................... 1
2............ Commencement................................................................................... 1
3............ Authority............................................................................................. 1
4............ Schedules............................................................................................ 1
5............ General medical services table............................................................. 1
6............ Dictionary........................................................................................... 1
Schedule 1—General medical services table 2
Part 1—Preliminary 2
Division 1.1—Interpretation 2
1.1.1...... Meaning of eligible non‑vocationally recognised medical practitioner 2
1.1.1A... Meaning of general practitioner......................................................... 3
1.1.2...... Meaning of multidisciplinary case conference.................................... 4
1.1.3...... Meaning of multidisciplinary case conference team........................... 5
1.1.4...... Meaning of single course of treatment................................................ 6
1.1.5...... Meaning of symbol (G)...................................................................... 7
1.1.6...... Meaning of symbol (H)...................................................................... 7
1.1.7...... Meaning of symbol (S)....................................................................... 7
Division 1.2—General application provisions 9
1.2.1...... Application.......................................................................................... 9
1.2.2...... Attendance by specialist or consultant physician................................. 9
1.2.3...... Professional attendance services......................................................... 9
1.2.4...... Personal attendance by medical practitioners generally..................... 10
1.2.5...... Personal attendance by medical practitioners..................................... 11
1.2.6...... Consultant occupational physician.................................................... 12
1.2.7...... Application of items—services provided with non‑medicare services 12
1.2.7A... Application of items—services provided with autologous injections of blood or blood products 12
1.2.8...... Services that may be provided by persons other than medical practitioners 12
1.2.9...... Meaning of participating in a video conferencing consultation........ 13
Part 2—Services and fees 14
Division 2.1—Groups A1 to A10 14
2.1.1...... Meaning of amount under clause 2.1.1............................................ 14
Division 2.2—Group A1: General practitioner attendances to which no other item applies 17
Division 2.3—Group A2: Other non‑referred attendances to which no other item applies 22
2.3.1...... Effect of determination under section 106TA of Act......................... 22
Division 2.4—Group A3: Specialist attendances to which no other item applies 26
2.4.1...... Limitation of item 99......................................................................... 26
Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies 29
2.5.1...... Limitation of items 112 to 114.......................................................... 29
Division 2.5A—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability 33
2.5A.1... Meanings of eligible allied health provider and risk assessment...... 33
2.5A.2... Meaning of eligible disability............................................................ 33
Division 2.6—Group A28: Geriatric medicine 37
2.6.1...... Limitation of item 149....................................................................... 37
Division 2.7—Group A5: Prolonged attendances to which no other item applies 42
2.7.1...... Application of items 160 to 164........................................................ 42
Division 2.8—Group A6: Group therapy 43
Division 2.9—Group A7: Acupuncture 44
2.9.1...... Meaning of qualified medical acupuncturist..................................... 44
Division 2.10—Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies 47
2.10.1.... Application of items 291, 293 and 359............................................. 47
2.10.2.... Application of items 342, 344 and 346............................................. 47
2.10.3.... Restriction of telepsychiatry consultations to regional, rural and remote areas 47
2.10.4.... Limitation of item 288....................................................................... 47
2.10.5.... Meanings of eligible allied health provider and risk assessment...... 47
Division 2.11—Group A12: Consultant occupational physician attendances to which no other item applies 61
2.11.1.... Limitation of items 384 and 389........................................................ 61
Division 2.12—Group A13: Public health physician attendances to which no other item applies 63
2.12.1.... Public health physicians.................................................................... 63
Division 2.13—Miscellaneous services 66
Division 2.14—Group A21: Emergency physician attendances to which no other item applies 67
2.14.1.... Meaning of recognised emergency department................................ 67
2.14.2.... Meaning of problem focussed history............................................... 67
2.14.3.... Attendance for emergency evaluation of critically ill patients............ 67
Division 2.15—Group A11: Urgent attendances after hours 71
2.15.1.... Meaning of patient’s medical condition requires urgent treatment.. 71
2.15.2.... Meaning of responsible person........................................................ 71
2.15.3.... Application of Group A11................................................................ 71
2.15.4.... Effect of determination under section 106TA of Act......................... 72
Division 2.16—Group A14: Health assessments 74
2.16.1.... Application of Group A14................................................................ 74
2.16.2.... Types of health assessments............................................................. 74
2.16.3.... Application of item 715 to certain patients only................................ 76
2.16.4.... Healthy Kids Check.......................................................................... 76
2.16.5.... Type 2 Diabetes Risk Evaluation...................................................... 78
2.16.6.... 45 year old Health Assessment......................................................... 79
2.16.7.... Older Person’s Health Assessment................................................... 80
2.16.8.... Comprehensive Medical Assessment for permanent resident of residential aged care facility 81
2.16.9.... Health assessment for a person with an intellectual disability........... 82
2.16.10.. Health assessment for a refugee or other humanitarian entrant.......... 84
2.16.10A........ Australian Defence Force Post‑discharge GP Health Assessment 85
2.16.11.. Aboriginal and Torres Strait Islander child health assessment.......... 87
2.16.12.. Aboriginal and Torres Strait Islander adult health assessment.......... 89
2.16.13.. Aboriginal and Torres Strait Islander Older Person’s Health Assessment 90
2.16.14.. Restrictions on health assessments for Group A14........................... 92
Division 2.17—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences 94
Subdivision A—General 94
2.17.1.... Service by medical practitioners........................................................ 94
Subdivision B—Subgroup 1 of Group A15 94
2.17.2.... Meaning of associated medical practitioner..................................... 94
2.17.3.... Meaning of contribute to a multidisciplinary care plan.................... 94
2.17.4.... Meaning of coordinating the development of team care arrangements 95
2.17.5.... Meaning of coordinating a review of team care arrangements........ 96
2.17.6.... Meaning of multidisciplinary care plan............................................ 97
2.17.7.... Meaning of preparing a GP management plan................................ 97
2.17.8.... Meaning of reviewing a GP management plan................................. 98
2.17.9.... Application of items 721, 723, 729, 731 and 732............................. 99
2.17.10.. Application of items 701 to 723 and 732........................................ 100
2.17.10A................... Application of items in relation to items 721, 723 and 732 100
2.17.11.. Limitation on items 721, 723, 729, 731 and 732............................. 100
Subdivision C—Subgroup 2 of Group A15 104
2.17.12.. Meaning of multidisciplinary discharge case conference............... 104
2.17.13.. Meaning of multidisciplinary case conference in a residential aged care facility 104
2.17.14.. Meaning of organise and coordinate.............................................. 104
2.17.15.. Meaning of participate.................................................................... 105
2.17.16.. Meaning of coordinating................................................................ 105
2.17.17.. Meaning of case conference team................................................... 106
2.17.18.. Application of item 880................................................................... 106
Division 2.18—Group A17: Domiciliary and residential medication management reviews 113
2.18.1.... Meaning of living in a community setting....................................... 113
2.18.2.... Meaning of residential medication management review................. 113
2.18.3.... Application of items 900 and 903................................................... 114
Division 2.18A—Group A30: Medical practitioner video conferencing consultation 116
2.18A.1. Application of items........................................................................ 116
2.18A.2. Application of items 2125, 2138, 2179 and 2220........................... 116
2.18A.3. Meaning of amount under clause 2.18A.3...................................... 116
2.18A.4. Limitation of items.......................................................................... 117
Division 2.19—Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies) 123
2.19.1.... Application of Subgroup 2 of Groups A18 and A19...................... 123
2.19.2.... Application of Subgroup 3 of Groups A18 and A19...................... 124
Division 2.20—Group A20: Mental health care 136
2.20.1.... Definitions...................................................................................... 136
2.20.2.... Meaning of amount under clause 2.20.2........................................ 136
2.20.3.... Meaning of preparation of a GP mental health treatment plan...... 137
2.20.4.... Meaning of review of a GP mental health treatment plan............... 138
2.20.5.... Meaning of associated medical practitioner................................... 139
2.20.6.... Application of Subgroup 1 of Group A20...................................... 139
2.20.7.... Focussed psychological strategies................................................... 141
Division 2.21—Group A24: Palliative and pain medicine 145
2.21.1.... Meaning of organise and coordinate.............................................. 145
2.21.2.... Meaning of participate.................................................................... 145
2.21.3.... Application of Group A24.............................................................. 146
2.21.4.... Limitation on items.......................................................................... 146
2.21.5.... Limitation of items.......................................................................... 146
Division 2.22—Group A27: Pregnancy support counselling 155
2.22.1.... Application of item 4001................................................................. 155
Division 2.23—Group A22: General practitioner after‑hours attendances to which no other item applies 157
2.23.1.... Application of Group A22.............................................................. 157
Division 2.24—Group A23: Other non‑referred after‑hours attendances to which no other item applies 162
2.24.1.... Application of Group A23.............................................................. 162
Division 2.26—Group A26: Neurosurgery attendances to which no other item applies 165
2.26.1.... Limitation of items 6004 and 6016.................................................. 165
Division 2.27—Group A9: Contact lenses 168
2.27.1.... Application of item 10809............................................................... 168
Division 2.28—Group A10: Optometric services provided by participating optometrist 171
2.28.1.... Applications of items 10940 and 10941.......................................... 171
2.28.2.... Application of item 10929............................................................... 171
2.28.3.... Limitation on items.......................................................................... 171
2.28.4.... Application of items 10931, 10932 and 10933............................... 171
2.28.5.... Limitation of item 10943................................................................. 172
2.28.6.... Meaning of old item 10900............................................................. 172
Division 2.29—Miscellaneous services 181
Division 2.30—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 182
2.30.1.... Definitions for item 10997.............................................................. 182
2.30.2.... Application of item 10986............................................................... 182
2.30.3.... Restrictions on item 10986.............................................................. 183
2.30.4.... Application of item 10988............................................................... 183
2.30.5.... Application of item 10989............................................................... 183
2.30.6.... Limitation of item 10983................................................................. 184
Division 2.31—Group M1: Management of bulk‑billed services 187
2.31.1.... Definitions for Division 2.31.......................................................... 187
2.31.2.... Application of items 10990, 10991 and 10992............................... 189
Division 2.33—Diagnostic procedures and investigations 191
Division 2.34—Group D1: Miscellaneous diagnostic procedures and investigations 192
2.34.1.... Meaning of report........................................................................... 192
2.34.2.... Meaning of qualified sleep medicine practitioner........................... 192
Division 2.35—Group D2: Nuclear medicine (non‑imaging) 216
2.35.1.... Application of Group D2................................................................ 216
Division 2.37—Group T1: Miscellaneous therapeutic procedures 217
2.37.1.... Meaning of comprehensive hyperbaric medicine facility................ 217
2.37.2.... Meaning of embryology laboratory services.................................. 217
2.37.3.... Meaning of treatment cycle............................................................. 218
2.37.4.... Items provided as part of treatment cycle relating to assisted reproductive services not to apply 218
2.37.5.... Application of items 13020 to 14245.............................................. 219
2.37.6.... Limitation on item 13104................................................................ 219
2.37.7.... Items relating to assisted reproductive services not to apply in certain pregnancy‑related circumstances 219
2.37.8.... Application of items 14227 to 14242.............................................. 219
2.37.9.... Application of item 14245............................................................... 219
2.37.10.. Limitation of item 13210................................................................. 220
Division 2.38—Group T2: Radiation oncology 233
2.38.1.... Meaning of amount under clause 2.38.1........................................ 233
2.38.2.... Meaning of approved site............................................................... 233
2.38.3.... Application of Group T2................................................................. 234
2.38.4.... Application of items 15556, 15559 and 15562............................... 234
Division 2.39—Group T3: Therapeutic nuclear medicine 246
2.39.1.... Application of Group T3................................................................. 246
Division 2.40—Group T4: Obstetrics 247
2.40.1.... Definitions for item 16400.............................................................. 247
2.40.2.... Meaning of amount under clause 2.40.2........................................ 247
2.40.3.... Meaning of delivery........................................................................ 247
2.40.4.... Application of Group T4................................................................. 248
2.40.5.... Application of item 16400............................................................... 248
2.40.5A. Limitation of item 16399................................................................. 249
2.40.6.... Limitation of items 16590 and 16591.............................................. 249
Division 2.41—Group T6: Examination by anaesthetist 255
2.41.1.... Application of Group T6................................................................. 255
2.41.2.... Limitation of item 17609................................................................. 255
Division 2.42—Group T7: Regional or field nerve blocks 259
2.42.1.... Meaning of amount under clause 2.42.1........................................ 259
2.42.2.... Application of Group T7................................................................. 259
Division 2.42A—Group T11: Botulinum toxin 263
2.42A.1. Supply of botulinum toxin.............................................................. 263
2.42A.2. Limitation of certain items............................................................... 263
Division 2.43—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide) 269
2.43.1.... Meaning of amount under clause 2.43.1........................................ 269
2.43.2.... Meaning of amount under clause 2.43.2........................................ 270
2.43.3.... Meaning of complex paediatric case............................................... 270
2.43.4.... Meaning of service time.................................................................. 270
2.43.5.... Application of Group T10............................................................... 271
2.43.6.... Application of Subgroup 21 of Group T10..................................... 271
2.43.7.... Services mentioned in Subgroups 21 to 25 of Group T10.............. 272
2.43.8.... Application of Subgroups 22 and 23 of Group T10....................... 272
2.43.9.... Application of Subgroups 24 and 25 of Group T10....................... 272
Division 2.44—Group T8: Surgical operations 310
Subdivision A—General 310
2.44.1.... Meaning of approved site............................................................... 310
2.44.2.... Application of Group T8................................................................. 310
Subdivision B—Subgroup 1 of Group T8 310
2.44.4.... Meaning of amount under clause 2.44.4........................................ 310
2.44.5.... Meaning of amount under clause 2.44.5........................................ 310
2.44.6.... Meaning of qualified surgeon......................................................... 310
2.44.7.... Meaning of qualified radiologist..................................................... 311
2.44.8.... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures........................................................................................................ 311
2.44.9.... Application of items 30299 and 30300........................................... 311
2.44.10.. Application of items 30440, 30451, 30492 and 30495................... 311
2.44.11.. Application of items 30688, 30690, 30692 and 30694................... 312
2.44.12.. Application of item 35412............................................................... 312
2.44.12A Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590 312
Subdivision C—Subgroups 2 and 3 of Group T8 362
2.44.13.. Meaning of foreign body in items 35360 to 35363......................... 362
2.44.14.. Application of items 32500 to 32517 and 35321............................ 362
2.44.15.. Application of items 35404, 35406 and 35408............................... 362
2.44.15A........................................................................ Sacral nerve stimulation 363
2.44.15B...................................................................... Artificial bowel sphincter 363
Subdivision D—Subgroups 4, 5 and 6 of Group T8 389
2.44.17.. Application of items 38470 to 38766.............................................. 389
Subdivision E—Subgroups 7 to 11 of Group T8 435
Subdivision F—Subgroups 12 and 13 471
2.44.18.. Meaning of amount under clause 2.44.18...................................... 471
2.44.19.. Meaning of maxilla......................................................................... 472
Subdivision G—Subgroup 14 497
2.44.20.. Items 46300 to 46534 apply only in certain circumstances............. 497
Subdivision H—Subgroup 15 504
2.44.21.. Limitation of item 50303................................................................. 504
Division 2.45—Group T9: Assistance at operations 549
2.45.1.... Meaning of amount under clause 2.45.1........................................ 549
2.45.2.... Meaning of amount under clause 2.45.2........................................ 549
2.45.3.... Meaning of amount under clause 2.45.3........................................ 549
2.45.4.... Meaning of previous significant surgical complication.................. 549
2.45.5.... Application of Group T9................................................................. 550
2.45.6.... Assistance at operations.................................................................. 550
Division 2.46—Oral and Maxillofacial services 552
2.46.1.... Application of Groups O1 to O11.................................................. 552
Division 2.47—Group O1: Consultations 553
Division 2.48—Group O2: Assistance at operation 554
2.48.1.... Meaning of amount under clause 2.48.1........................................ 554
2.48.2.... Assistance at operations.................................................................. 554
Division 2.49—Group O3: General surgery 555
Division 2.50—Group O4: Plastic and reconstructive 562
2.50.1.... Meaning of maxilla......................................................................... 562
Division 2.51—Group O5: Preprosthetic 567
Division 2.52—Group O6: Neurosurgical 568
Division 2.53—Group O7: Ear, nose and throat 569
Division 2.54—Group O8: Temporomandibular joint 571
Division 2.55—Group O9: Treatment of fractures 573
Division 2.56—Group O10: Diagnostic procedures and investigations 575
Division 2.57—Group O11: Regional or field nerve blocks 576
Part 3—Dictionary 577
Schedule 2—Repeals 589
Health Insurance (General Medical Services Table) Regulation 2014 589
1 Name
This is the Health Insurance (General Medical Services Table) Regulation 2015.
2 Commencement
This instrument commences on 1 July 2015.
3 Authority
This instrument is made under the Health Insurance Act 1973.
4 Schedules
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.
5 General medical services table
For subsection 4(1) of the Act, this instrument prescribes a table of medical services set out in Schedule 1.
6 Dictionary
The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.
Schedule 1—General medical services table
Note: See section 5.
Part 1—Preliminary
Division 1.1—Interpretation
1.1.1 Meaning of eligible non‑vocationally recognised medical practitioner
(1) In the table:
eligible non‑vocationally 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.
1.1.1A Meaning of general practitioner
In the table:
general practitioner means:
(a) a practitioner who is vocationally registered under section 3F of the Act; or
(b) a practitioner who:
(i) is a Fellow of the RACGP; and
(ii) participates in the quality assurance and continuing medical education program of the RACGP; and
(iii) meets the RACGP requirements for quality assurance and continuing education; or
(c) a practitioner in relation to whom a determination is in force under regulation 6DA of the Health Insurance Regulations 1975 recognising that he or she meets the fellowship standards of the ACRRM; or
(d) a practitioner who is undertaking a placement in general practice that is approved by 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; or
(e) an eligible non‑vocationally recognised medical practitioner; or
(g) a practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited.
1.1.2 Meaning of multidisciplinary case conference
A 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.
1.1.3 Meaning of multidisciplinary case conference team
(1) A multidisciplinary case conference team for a patient:
(a) includes a medical practitioner; and
(b) either:
(i) for items 735 to 758—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 a family 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 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.
1.1.4 Meaning of single course of treatment
(1) Use this clause for:
(a) items 104 to 131, 133, 384 to 388, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6015, 16401, 16404, 16406, 51700 and 51703; and
(b) the meaning of attendance in clause 1.1.1; and
(c) the meaning of symbol (S) in clause 1.1.10; and
(d) the definition of minor attendance in the Dictionary.
(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 regulation 31 of the Health Insurance Regulations 1975 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.
1.1.5 Meaning of symbol (G)
An item including the symbol (G) applies only to a service not provided by a specialist in the practice of his or her specialty.
1.1.6 Meaning of symbol (H)
An item including the symbol (H) applies only to a service performed or provided in a hospital.
1.1.7 Meaning of symbol (S)
(1) An item including the symbol (S) applies only to a service performed by a specialist in the practice of his or her specialty, if:
(a) the service is:
(i) provided to a patient who has been referred to the specialist; and
(ii) the first service performed by the specialist in accordance with the referral; or
(b) the service is:
(i) provided to a patient who has been referred to the specialist; and
(ii) part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and
(iii) provided within the period of validity of the referral that is applicable under regulation 31 of the Health Insurance Regulations 1975; or
(c) the service is:
(i) provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and
(ii) the first service performed by the specialist in accordance with the referral; or
(d) the service is:
(i) provided to a patient who has not been referred to the specialist; and
(ii) a service that, in an emergency, the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.
(2) In this clause:
emergency has the same meaning as in subregulation 30(5) of the Health Insurance Regulations 1975.
Division 1.2—General application provisions
1.2.1 Application
An item in Part 2 does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.
1.2.2 Attendance by specialist or consultant physician
(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, 13210, 16399, 16401, 16404, 17609 and 17640 to 17655.
(2) An attendance on a patient by a specialist or consultant physician:
(a) includes an attendance on a patient if:
(i) the patient declares that a written referral of the patient was completed by a medical practitioner; or
(ii) in an emergency, the patient has not been referred to the specialist, or consultant physician, if the specialist or consultant physician decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but
(b) does not include an attendance on a patient if:
(i) the attendance forms part of a single course of treatment for the patient in which the first service was provided to the patient more than 12 months (or another period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been made.
(3) In this clause:
emergency has the same meaning as in subregulation 30(5) of the Health Insurance Regulations 1975.
1.2.3 Professional attendance services
(1) Use this clause for items 3 to 338, 348 to 389, 410 to 417, 501 to 600, 900, 903, 2497 to 2840, 3003, 3005 to 3028, 5000 to 5267, 6004, 6007 to 6016, 10905 to 10929, 13210, 16399, 16401, 16404, 16406, 16590, 16591 and 17609 to 17690.
(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 96 and 5000 to 5267; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
1.2.4 Personal attendance by medical practitioners generally
(1) Use this clause for items 3 to 149, 173 to 338, 348 to 536, 597 to 600, 2100 to 2220, 2497 to 2840, 3003, 3005 to 3028, 4001 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11724, 11921 to 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512 and 16515 to 51318.
(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, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.
1.2.5 Personal attendance by medical practitioners
(1) Use this clause for items 3 to 723, 732, 900 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11722, 11724, 11820, 11823, 11921, 12000, 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512, 16515 to 51318.
(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, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.
1.2.6 Consultant occupational physician
A fee specified for an attendance by a consultant occupational physician applies 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 non‑compensable accident, injury or ill‑health;
(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.
1.2.7 Application of items—services provided with non‑medicare services
Items 3 to 10943 do not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.
1.2.7A Application of items—services provided with autologous injections of blood or blood products
An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time, or in connection with, an injection of blood or a blood product that is autologous.
1.2.8 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, 11222, 11224, 11225, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11700, 11702, 11708, 11709, 11710, 11711, 11712, 11713, 11715, 11718, 11721, 11727, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12015, 12018, 12021, 12200, 12203, 12207, 12210, 12213, 12215, 12217, 12250, 12500 to 12530, 13015, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 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.
1.2.9 Meaning of participating in a video conferencing consultation
A medical practitioner is participating in a video conferencing consultation if the medical practitioner attends a patient who is receiving a service under an item in the table from a specialist or consultant physician who is providing the service:
(a) in relation to his or her speciality to the patient; and
(b) by way of a video conferencing consultation.
Part 2—Services and fees
Division 2.1—Groups A1 to A10
Note: Groups A1 to A10 include Groups A1, A2, A3, A4, A28, A5, A6, A7, A8, A12, A13, A21, A11, A14, A15, A17, A18, A19, A20, A24, A27, A22, A23, A26, A9 and A10.
2.1.1 Meaning of amount under clause 2.1.1
In an item of the table 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
Item/s of the table
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
25.95
2.00
2
20
The fee for item 3
46.70
3.30
3
24
The fee for item 23
25.95
2.00
4
35
The fee for item 23
46.70
3.30
5
37
The fee for item 36
25.95
2.00
6
43
The fee for item 36
46.70
3.30
7
47
The fee for item 44
25.95
2.00
8
51
The fee for item 44
46.70
3.30
9
58
$8.50
15.50
0.70
10
59, 2610, 2631, 2673
$16.00
17.50
0.70
11
60, 2613, 2633, 2675
$35.50
15.50
0.70
12
65, 2616, 2635, 2677
$57.50
15.50
0.70
13
92
$8.50
27.95
1.25
14
93
$16.00
31.55
1.25
15
95
$35.50
27.95
1.25
16
96
$57.50
27.95
1.25
17
195
The fee for item 193
25.95
2.00
18
414
The fee for item 410
25.45
1.95
19
415
The fee for item 411
25.45
1.95
20
416
The fee for item 412
25.45
1.95
21
417
The fee for item 413
25.45
1.95
22
2503
The fee for item 2501
25.95
2.00
23
2506
The fee for item 2504
25.95
2.00
24
2509
The fee for item 2507
25.95
2.00
25
2518
The fee for item 2517
25.95
2.00
26
2522
The fee for item 2521
25.95
2.00
27
2526
The fee for item 2525
25.95
2.00
28
2547
The fee for item 2546
25.95
2.00
29
2553
The fee for item 2552
25.95
2.00
30
2559
The fee for item 2558
25.95
2.00
31
5003
The fee for item 5000
25.95
2.00
32
5010
The fee for item 5000
46.70
3.30
33
5023
The fee for item 5020
25.95
2.00
34
5028
The fee for item 5020
46.70
3.30
35
5043
The fee for item 5040
25.95
2.00
36
5049
The fee for item 5040
46.70
3.30
37
5063
The fee for item 5060
25.95
2.00
38
5067
The fee for item 5060
46.70
3.30
39
5220
$18.50
15.50
0.70
40
5223
$26.00
17.50
0.70
41
5227
$45.50
15.50
0.70
42
5228
$67.50
15.50
0.70
43
5260
$18.50
27.95
1.25
44
5263
$26.00
31.55
1.25
45
5265
$45.50
27.95
1.25
46
5267
$67.50
27.95
1.25
Division 2.2—Group A1: General practitioner attendances to which no other item applies
Group A1—General practitioner attendances to which no other item applies
Item
Description
Fee ($)
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—each attendance
16.95
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 the table 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
20
Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained 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
23
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table 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 health‑related issues, with appropriate documentation—each attendance
37.05
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 the table 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 health‑related 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
35
Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table 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 health‑related 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
36
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table 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 health‑related issues, with appropriate documentation—each attendance
71.70
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 the table 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 health‑related 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
43
Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table 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 health‑related 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
44
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table 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 health‑related issues, with appropriate documentation—each attendance
105.55
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 the table 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 health‑related 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
51
Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table 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 health‑related 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 2.3—Group A2: Other non‑referred attendances to which no other item applies
2.3.1 Effect of determination under section 106TA of Act
(1) This clause applies to a general practitioner, if:
(a) the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and
(b) the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and
(c) the determination states that the practitioner is disqualified for a service mentioned in an item in Group A1; and
(d) the practitioner provides a service mentioned in an item in Group A2.
(2) The determination applies to the service mentioned in paragraph (1)(d).
Group A2—Other non‑referred attendances to which no other item applies
Item
Description
Fee ($)
52
Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
11.00
53
Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
21.00
54
Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
38.00
57
Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
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 the table applies), not more than 5 minutes in duration—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 general practitioner to whom clause 2.3.1 applies
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 the table applies) of more than 5 minutes in duration 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 general practitioner to whom clause 2.3.1 applies
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 the table applies) of more than 25 minutes in duration 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 general practitioner to whom clause 2.3.1 applies
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 the table applies) of more than 45 minutes in duration—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 general practitioner to whom clause 2.3.1 applies
Amount under clause 2.1.1
92
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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of not more than 5 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
Amount under clause 2.1.1
93
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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
Amount under clause 2.1.1
95
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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
Amount under clause 2.1.1
96
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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 45 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:
(a) a medical practitioner (who is not a general practitioner); or
(b) a general practitioner to whom clause 2.3.1 applies
Amount under clause 2.1.1
Division 2.4—Group A3: Specialist attendances to which no other item applies
2.4.1 Limitation of item 99
Item 99 does not apply if the patient or the specialist
travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
Group A3—Specialist attendances to which no other item applies
Item
Description
Fee ($)
99
Professional attendance on a patient by a specialist practising in his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; 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 his or her specialty after referral of the patient to him or her—each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies
85.55
105
Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital
43.00
106
Professional attendance by a specialist in the practice of his or her specialty of ophthalmology and following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) 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)
71.00
107
Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment), if that attendance is at a place other than consulting rooms or hospital
125.50
108
Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—each attendance after the first in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital
79.45
109
Professional attendance by a specialist in the practice of his or her specialty of ophthalmology following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) 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)
192.80
113
Initial professional attendance of 10 minutes or less in duration on a patient by a specialist in the practice of his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; 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
64.20
Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies
2.5.1 Limitation of items 112 to 114
Items 112, 113 and 114 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:
(a) for item 112—sub‑subparagraph (d)(i)(B) of the item; and
(b) for items 113 and 114—sub‑subparagraph (c)(i)(B) of the item.
Group A4—Consultant physician attendances to which no other item applies
Item
Description
Fee ($)
110
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
150.90
112
Professional attendance on a patient by a consultant physician practising in his or her 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 kms by road from the physician; or
(ii) is a care recipient in a residential care service; or
50% of the fee for item 110, 116, 119, 132 or 133
(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
114
Initial professional attendance of 10 minutes or less in duration on a patient by a consultant physician practising in his or her 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 kms by road from the physician; or
(ii) is a care recipient in a residential care service; 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
113.20
116
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 119 applies) after the first in a single course of treatment
75.50
119
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment
43.00
122
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
183.10
128
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 131 applies) after the first in a single course of treatment
110.75
131
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment
79.75
132
Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 45 minutes in duration 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 him or her 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
263.90
133
Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 20 minutes in duration after the first 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
132.10
Division 2.5A—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability
2.5A.1 Meanings of eligible allied health provider and risk assessment
In items 135, 137 and 139:
eligible allied health provider means any of the following:
(a) an audiologist;
(b) an occupational therapist;
(c) a participating optometrist;
(d) an orthoptist;
(e) a physiotherapist;
(f) a psychologist;
(g) a speech pathologist.
risk assessment means an assessment of:
(a) the risk to the patient of a contributing co‑morbidity; and
(b) environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.
2.5A.2 Meaning of eligible disability
An eligible disability means any of the following:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(c) deafblindness;
(d) cerebral palsy;
(e) Down syndrome;
(f) Fragile X syndrome;
(g) Prader‑Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith‑Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex; and
(ii) a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence;
(p) Rett’s disorder.
Group A29—Early intervention services for children with autism, pervasive developmental disorder or disability
Item
Description
Fee ($)
135
Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of his or her 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)
263.90
137
Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a specialist or consultant physician (not including a general practitioner) 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 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)
263.90
139
Professional attendance of at least 45 minutes in duration 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)
132.50
Division 2.6—Group A28: Geriatric medicine
2.6.1 Limitation of item 149
Item 149 does not apply if the patient, physician or
specialist travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
Group A28—Geriatric medicine
Item
Description
Fee ($)
141
Professional attendance of more than 60 minutes in duration at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her 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
452.65
143
Professional attendance of more than 30 minutes in duration at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her 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
282.95
145
Professional attendance of more than 60 minutes in duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her 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
548.85
147
Professional attendance of more than 30 minutes in duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her 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
343.10
149
Professional attendance on a patient by a consultant physician or specialist practising in his or her 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 kms by road from the physician or specialist; or
(ii) is a care recipient in a residential care service; 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 2.7—Group A5: Prolonged attendances to which no other item applies
2.7.1 Application of items 160 to 164
(1) Items 160 to 164 apply only to a service provided in the course of a personal attendance by one or more medical practitioners on a single patient on a single occasion.
(2) If the personal attendance is provided by one or more medical practitioners concurrently, each practitioner 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.
Group A5—Prolonged attendances to which no other item applies
Item
Description
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
221.50
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
369.15
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
516.65
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
664.55
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
738.40
Division 2.8—Group A6: Group therapy
Group A6—Group therapy
Item
Description
Fee ($)
170
Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 2 patients
117.55
171
Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 3 patients
123.85
172
Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 4 or more patients
150.70
Division 2.9—Group A7: Acupuncture
2.9.1 Meaning of qualified medical acupuncturist
A general practitioner is a qualified medical acupuncturist, for an item, if the Chief Executive Medicare has received a written notice from the Royal Australian College of General Practitioners stating that the general practitioner meets the skills requirements for providing the service described in the item.
Group A7—Acupuncture
Item
Description
Fee ($)
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 health‑related 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
37.05
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 health‑related 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 health‑related 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
71.70
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 health‑related 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
105.55
Division 2.10—Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies
2.10.1 Application of items 291, 293 and 359
Items 291, 293 and 359 may only apply once in a 12 month period.
2.10.2 Application of 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.
2.10.3 Restriction of telepsychiatry consultations to regional, rural and remote areas
Items 353 to 361 apply only to a consultation that is provided to a patient in a regional, rural or remote area.
2.10.4 Limitation of item 288
Item 288 does not apply if the patient or physician travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
2.10.5 Meanings of eligible allied health provider and risk assessment
In item 289:
eligible allied health provider means any of the following:
(a) an audiologist;
(b) an occupational therapist;
(c) a participating optometrist;
(d) an orthoptist;
(e) a physiotherapist;
(f) a psychologist;
(g) a speech pathologist.
risk assessment means an assessment of:
(a) the risk to the patient of a contributing co‑morbidity; and
(b) environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.
Group A8—Consultant psychiatrist attendances to which no other item applies
Item
Description
Fee ($)
288
Professional attendance on a patient by a consultant physician practising in his or her 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 kms by road from the physician; or
(ii) is a care recipient in a residential care service; 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 of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of psychiatry, 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 under 13 years with autism or another pervasive developmental disorder, if the consultant psychiatrist 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)
263.90
291
Professional attendance of more than 45 minutes in duration at consulting rooms by a consultant physician in the practice of his or her 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
452.65
293
Professional attendance of more than 30 minutes but not more than 45 minutes in duration at consulting rooms by a consultant physician in the practice of his or her 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
282.95
296
Professional attendance of more than 45 minutes in duration by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance at consulting rooms if the patient:
(a) is a new patient for this consultant psychiatrist; or
(b) has not received a professional attendance from this consultant psychiatrist 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
260.30
297
Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance at hospital if the patient:
(a) is a new patient for this consultant psychiatrist; or
(b) has not received a professional attendance from this consultant psychiatrist 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)
260.30
299
Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her 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 psychiatrist; or
(b) has not received a professional attendance from this consultant psychiatrist 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
311.30
300
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration 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
43.35
302
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration 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
86.45
304
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration 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
133.10
306
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration 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
183.65
308
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration 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
213.15
310
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration 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
21.60
312
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration 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
43.35
314
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration 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
66.65
316
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration 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
91.95
318
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration 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
106.60
319
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes in duration at consulting rooms, if the patient has:
(a) been diagnosed as suffering severe personality disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, substance‑related 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
183.65
320
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration at hospital
43.35
322
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration at hospital
86.45
324
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration at hospital
133.10
326
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration at hospital
183.65
328
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration at hospital
213.15
330
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration if that attendance is at a place other than consulting rooms or hospital
79.55
332
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration if that attendance is at a place other than consulting rooms or hospital
124.65
334
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration if that attendance is at a place other than consulting rooms or hospital
181.65
336
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration if that attendance is at a place other than consulting rooms or hospital
219.75
338
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration if that attendance is at a place other than consulting rooms or hospital
249.55
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) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of his or her 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
49.30
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) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of his or her 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
65.45
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) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of his or her 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
96.80
348
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes, but less than 45 minutes, in duration, in the course of initial diagnostic evaluation of a patient
126.75
350
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 45 minutes in duration, in the course of initial diagnostic evaluation of a patient
175.00
352
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes in duration, 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
126.75
353
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of not more than 15 minutes in duration, 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
57.20
355
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 15 minutes, but not more than 30 minutes, in duration, 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
114.45
356
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 30 minutes, but not more than 45 minutes, in duration, 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
167.80
357
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 45 minutes, but not more than 75 minutes, in duration, 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
231.45
358
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 75 minutes in duration, 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
282.00
359
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry—a telepsychiatry consultation of more than 30 minutes but not more than 45 minutes in duration, 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 psychiatrist 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 referring 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) 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
325.35
361
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a telepsychiatry consultation of more than 45 minutes in duration, if the patient:
(a) either:
(i) is a new patient for this consultant psychiatrist; or
(ii) has not received a professional attendance from this consultant psychiatrist 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
299.30
364
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of not more than 15 minutes in duration, 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
43.35
366
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 15 minutes, but not more than 30 minutes, in duration, 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
86.45
367
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 30 minutes, but not more than 45 minutes, in duration, 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
133.10
369
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 45 minutes, but not more than 75 minutes, in duration, 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
183.80
370
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—a face‑to‑face consultation of more than 75 minutes in duration, 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
213.15
Division 2.11—Group A12: Consultant occupational physician attendances to which no other item applies
2.11.1 Limitation of items 384 and 389
Items 384 and 389 do not apply if the patient or physician travels to a place to satisfy the requirement in:
(a) for item 384—sub‑subparagraph (c)(i)(B) of the item; and
(b) for item 389—sub‑subparagraph (d)(i)(B) of the item.
Group A12—Consultant occupational physician attendances to which no other item applies
Item
Description
Fee ($)
384
Initial professional attendance of 10 minutes or less in duration on a patient by a consultant occupational physician practising in his or her 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 kms by road from the physician; or
(ii) is a care recipient in a residential care service; 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
64.20
385
Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
85.55
386
Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—each attendance after the first in a single course of treatment
43.00
387
Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
125.50
388
Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a referring practitioner—each attendance after the first in a single course of treatment
79.45
389
Professional attendance on a patient by a consultant occupational physician practising in his or her 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 kms by road from the physician; or
50% of the fee for item 385 or 386
(ii) is a care recipient in a residential care service; 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 2.12—Group A13: Public health physician attendances to which no other item applies
2.12.1 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.
Note: An exotic disease is medically accepted as a disease that is of foreign origin.
Group A13—Public health physician attendances to which no other item applies
Item
Description
Fee ($)
410
Professional attendance at consulting rooms by a public health physician in the practice of his or her 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
19.55
411
Professional attendance by a public health physician in the practice of his or her 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 health‑related issues, with appropriate documentation
42.75
412
Professional attendance by a public health physician in the practice of his or her 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 health‑related issues, with appropriate documentation
82.65
413
Professional attendance by a public health physician in the practice of his or her 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 health‑related issues, with appropriate documentation
121.70
414
Professional attendance at other than consulting rooms by a public health physician in the practice of his or her 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 his or her 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 health‑related issues, with appropriate documentation
Amount under clause 2.1.1
416
Professional attendance by a public health physician in the practice of his or her 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 health‑related issues, with appropriate documentation
Amount under clause 2.1.1
417
Professional attendance by a public health physician in the practice of his or her 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 health‑related issues, with appropriate documentation
Amount under clause 2.1.1
Division 2.13—Miscellaneous services
Note: Reserved for future use.
Division 2.14—Group A21: Emergency physician attendances to which no other item applies
2.14.1 Meaning of recognised emergency department
In this Division:
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.
2.14.2 Meaning of problem focussed history
In items 501, 503 and 507:
problem focussed history, for a patient, means a history focussing on the medical condition of the patient that necessitates the patient presenting for emergency attention.
2.14.3 Attendance for emergency evaluation of critically ill patients
In items 519 to 536, an attendance, for an emergency evaluation of a critically ill patient with an immediately life threatening problem, is an attendance that requires:
(a) immediate and rapid assessment; and
(b) initiation of resuscitation and electronic monitoring of vital signs; and
(c) taking a comprehensive history and evaluation while undertaking resuscitative measures; and
(d) ordering and evaluation of appropriate investigations; and
(e) transitional evaluation and monitoring; and
(f) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and
(g) initiation of appropriate treatment interventions; and
(h) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent.
Group A21—Emergency physician attendances to which no other item applies
Item
Description
Fee ($)
501
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving straightforward medical decision making that requires:
(a) taking a problem focussed history; and
(b) limited examination; and
(c) diagnosis; and
(d) initiation of appropriate treatment interventions
34.20
503
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of low complexity that requires:
(a) taking an expanded problem focussed history; and
(b) expanded examination of one or more systems; and
(c) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and
(d) initiation of appropriate treatment interventions
57.80
507
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires:
(a) taking an expanded problem focussed history; and
(b) expanded examination of one or more systems; and
(c) ordering and evaluation of appropriate investigations; and
(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and
(e) initiation of appropriate treatment interventions
97.05
511
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires:
(a) taking a detailed history; and
(b) detailed examination of one or more systems; and
(c) ordering and evaluation of appropriate investigations; and
(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and
(e) initiation of appropriate treatment interventions; and
(f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent
137.30
515
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for the unscheduled evaluation and management of a patient, involving medical decision making of high complexity that requires:
(a) taking a comprehensive history; and
(b) comprehensive examination of one or more systems; and
(c) ordering and evaluation of appropriate investigations; and
(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and
(e) initiation of appropriate treatment interventions; and
(f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent
212.60
519
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 30 minutes but less than 1 hour (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem
146.20
520
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 1 hour but less than 2 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem
280.85
530
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 2 hours but less than 3 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem
460.30
532
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 3 hours but less than 4 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem
639.75
534
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 4 hours but less than 5 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem
819.35
536
Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine—attendance for a total period (whether or not continuous) of at least 5 hours (before the patient’s admission to an in‑patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem
909.10
Division 2.15—Group A11: Urgent attendances after hours
2.15.1 Meaning of patient’s medical condition requires urgent treatment
(1) For items 597 to 600, a patient’s medical condition requires urgent treatment if:
(a) medical opinion is to the effect that the patient’s medical condition requires treatment within the unbroken after‑hours period in, or before, which the attendance mentioned in the item was requested; and
(b) treatment could not be delayed until the start of the next in‑hours period.
(2) For 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.
2.15.2 Meaning of responsible person
For items 597 to 600, a responsible person, for a patient:
(a) includes a spouse, parent, carer or guardian of the patient; but
(b) does not include:
(i) the attending medical practitioner; or
(ii) an employee of the attending medical practitioner; or
(iii) 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
(iv) a call centre; or
(v) a reception service.
2.15.3 Application of Group A11
Items 597 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 after‑hours 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 after‑hours periods at consulting rooms.
2.15.4 Effect of determination under section 106TA of Act
(1) This clause applies to a general practitioner if:
(a) the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and
(b) the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and
(c) the determination specifies the practitioner is disqualified in relation to a service mentioned in an item in Group A1; and
(d) the practitioner provides a service mentioned in item 598 or 600.
(2) The determination applies to the service mentioned in paragraph (1)(d).
Group A11—Urgent attendances after hours
Item
Description
Fee ($)
597
Professional attendance by a general practitioner on not more than one patient on one occasion—each attendance (other than an attendance in unsociable hours) in an after‑hours period if:
(a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period, and the patient’s medical condition requires urgent treatment; and
(b) if the attendance is performed at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance
129.80
598
Professional attendance by a medical practitioner (other than a general practitioner), or a general practitioner to whom clause 2.15.4 applies, on not more than one patient on one occasion—each attendance (other than an attendance in unsociable hours) in an after‑hours period if:
(a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period, and the patient’s medical condition requires urgent treatment; and
(b) if the attendance is at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance
104.75
599
Professional attendance by a general practitioner on not more than one patient on one occasion—each attendance in unsociable hours if:
(a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period, and the patient’s medical condition requires urgent treatment; and
(b) if the attendance is at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance
153.00
600
Professional attendance by a medical practitioner (other than a general practitioner), or a general practitioner to whom clause 2.15.4 applies, on not more than one patient on one occasion—each attendance in unsociable hours if:
(a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after‑hours period, and the patient’s medical condition requires urgent treatment; and
(b) if the attendance is at consulting rooms—it must be necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance
124.25
Division 2.16—Group A14: Health assessments
2.16.1 Application of Group A14
Items 701 to 715 apply only to a service provided in the course of a personal attendance by a single medical practitioner on a single patient.
2.16.2 Types of health assessments
(1) The following health assessments may be performed under item 701, 703, 705 or 707:
(a) a Healthy Kids Check, in accordance with clause 2.16.4, for a patient who is:
(i) at least 3 years old and under 5 years old; and
(ii) receiving or has received the immunisation recommended for a 4 year old child; and
(iii) not an in‑patient of a hospital;
(b) a Type 2 Diabetes Risk Evaluation, in accordance with clause 2.16.5, 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 in‑patient of a hospital;
(c) a 45 year old Health Assessment, in accordance with clause 2.16.6, 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 in‑patient of a hospital or a care recipient in a residential aged care facility;
(d) an Older Person’s Health Assessment, in accordance with clause 2.16.7, for a patient who is:
(i) at least 75 years old; and
(ii) not an in‑patient of a hospital or a care recipient in a residential aged care facility;
(e) a Comprehensive Medical Assessment, in accordance with clause 2.16.8, for a patient who is a permanent resident of a residential aged care facility;
(f) a health assessment, in accordance with clause 2.16.9, for a person with an intellectual disability, if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility;
(g) a health assessment, in accordance with clause 2.16.10, 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 in‑patient of a hospital or a care recipient in a residential aged care facility;
(h) an Australian Defence Force Post‑discharge GP Health Assessment, in accordance with clause 2.16.10A, 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.
Note: The Australian Type 2 Diabetes Risk Assessment Tool could in 2015 be viewed on the Department’s website (http://www.health.gov.au).
(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 (In‑country 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.
2.16.3 Application of item 715 to certain patients only
(1) The following health assessments may be performed under item 715:
(a) an Aboriginal and Torres Strait Islander child health assessment, in accordance with clause 2.16.11, for a patient if the patient is:
(i) of Aboriginal or Torres Strait Islander descent; and
(ii) under 15 years old; and
(iii) not an in‑patient of a hospital;
(b) an Aboriginal and Torres Strait Islander adult health assessment, in accordance with clause 2.16.12, for a patient if the patient is:
(i) of Aboriginal or Torres Strait Islander descent; and
(ii) at least 15 years old and under 55 years old; and
(iii) not an in‑patient 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 2.16.13, for a patient if the patient is:
(i) of Aboriginal or Torres Strait Islander descent; and
(ii) at least 55 years old; and
(iii) not an in‑patient of a hospital or a care recipient in a residential aged care facility.
(2) For this clause and item 715, a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.
2.16.4 Healthy Kids Check
(1) A Healthy Kids Check is the assessment of:
(a) a patient’s physical health, general wellbeing and development; and
(b) whether any medical intervention is required for the patient.
(2) The following may perform a Healthy Kids Check:
(a) a medical practitioner (including a general practitioner);
(b) a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf, and under the supervision, of a medical practitioner.
(3) If a practice nurse or a registered Aboriginal and Torres Strait Islander health practitioner performs a Healthy Kids Check for a patient and identifies any problems, the patient must be reviewed by the patient’s usual medical practitioner, who must arrange referrals and follow‑up services as required.
(4) A Healthy Kids Check for a patient must include the following basic physical examinations and assessments:
(a) measurement of the patient’s height and weight to calculate the patient’s body mass index and position on the growth curve;
(b) eyesight;
(c) hearing;
(d) oral health (teeth and gums);
(e) toileting;
(f) allergies.
(5) A Healthy Kids Check for a patient must also include:
(a) information collection, including taking a patient 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’s parent or carer, using the guide called Get Set 4 Life—habits for healthy kids.
Note: The Get Set 4 Life—habits for healthy kids guide could in 2015 be viewed on the Department’s website (http://www.health.gov.au).
(6) The person performing a Healthy Kids Check must:
(a) note if a copy of the guide mentioned in paragraph (5)(d) has been given to the patient’s parent or carer; and
(b) record evidence that the immunisation recommended for a 4 year old child has been given to the patient.
(7) The immunisation recommended for a 4 year old child may be given to a patient when he or she has a Healthy Kids Check, and may be claimed separately.
(8) The Healthy Kids Check must not be provided more than once to an eligible person.
2.16.5 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.
Note: The Australian Type 2 Diabetes Risk Assessment Tool could in 2015 be viewed on the Department’s website (http://www.health.gov.au).
(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
Note: Guidelines for examination and assessment include the Royal Australian College of General Practitioners publications Putting Prevention into Practice and Guidelines for Preventive Activities in General Practice. These documents could in 2015 be viewed on the Royal Australian College of General Practitioners’ website (http://www.racgp.org.au).
(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 follow‑up 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.
2.16.6 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 medical 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 medical 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.
2.16.7 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 medical 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.
2.16.8 Comprehensive Medical Assessment for permanent resident of residential aged care facility
(1) A Comprehensive Medical Assessment of a permanent resident of 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 medical 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.
2.16.9 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) non‑prescription 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 side‑effects 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) with reference to the Australian Immunisation Handbook, for appropriate vaccination schedules;
Note: The Australian Immunisation Handbook could in 2015 be viewed on the Department’s website (http://www.health.gov.au).
(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 gastro‑oesophageal 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 co‑morbid 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 medical 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 medical 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.
2.16.10 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 medical 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.
2.16.10A Australian Defence Force Post‑discharge GP Health Assessment
(1) An Australian Defence Force Post‑discharge 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 Post‑discharge GP Health Assessment Tool.
Note 1: The ADF Post‑discharge GP Health Assessment Tool could in 2015 be viewed on the Department of Veterans’ Affairs’ At Ease website (http://at‑ease.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 2015 be viewed on the Department of Veterans’ Affairs’ At Ease website (http://at‑ease.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.
2.16.11 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 medical practitioner; and
(b) taking the patient’s history, including the following:
(i) mother’s pregnancy history;
(ii) birth and neo‑natal 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 neo‑natal hearing screening);
(x) development (including achievement of age‑appropriate 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 self‑harm);
(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 age‑appropriate milestones have been achieved, if indicated;
(xi) assessment of parent and child interaction, if indicated;
(xii) other examinations in accordance with national or regional guidelines or specific regional needs, or 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).
2.16.12 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 medical 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 self‑harm);
(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 (in accordance with national or regional guidelines or specific regional needs):
(i) fasting blood sugar and lipids (by laboratory‑based 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).
2.16.13 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 medical 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.
2.16.14 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 medical practitioner, if reasonably practicable.
(4) Practice nurses and Aboriginal and Torres Strait Islander health practitioners may assist medical practitioners in performing a health assessment, in accordance with accepted medical practice, and under the supervision of the medical practitioner.
(5) For subclause (4), assistance may include activities associated with:
(a) information collection, and
(b) at the direction of the medical 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.
Group A14—Health assessments
Item
Description
Fee ($)
701
Professional attendance by a medical 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
59.35
703
Professional attendance by a medical 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
137.90
705
Professional attendance by a medical 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
190.30
707
Professional attendance by a medical 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
268.80
715
Professional attendance by a medical 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
212.25
Division 2.17—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences
Subdivision A—General
2.17.1 Service by 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 B—Subgroup 1 of Group A15
2.17.2 Meaning of associated medical practitioner
In item 732 associated medical practitioner means a general practitioner who, if not engaged in the same general practice as the medical practitioner mentioned in the item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).
2.17.3 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.
2.17.4 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 medical 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 (b)(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 a family carer of the patient.
2.17.5 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 medical 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 paragraphs 2.17.4(1)(b) and 2.17.7(a), as applicable; and
(b) if different arrangements need to be made—makes amendments to the plan, or to the document mentioned in paragraph 2.17.4(1)(b), 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 a family carer of the patient.
2.17.6 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 medical 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 medical 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 a family carer of the patient.
2.17.7 Meaning of preparing a GP management plan
In item 721:
preparing a GP management plan, for a patient, means a process by which a medical 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.
2.17.8 Meaning of reviewing a GP management plan
In item 732:
reviewing a GP management plan means a process by which a medical practitioner:
(a) reviews the matters mentioned in paragraph (a) of the definition of preparing a GP management plan in clause 2.17.7; 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.
2.17.9 Application of items 721, 723, 729, 731 and 732
(1) An item of the table mentioned in column 1 of table 2.17.9 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 2.17.9.
Table 2.17.9—Application of items 721, 723, 729, 731 and 732
Item
Column 1
Items of the table
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 in‑patient of a hospital; or
(b) is not a public in‑patient 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 in‑patient of a hospital; or
(ii) is not a public in‑patient 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 a family carer of the patient.
2.17.10 Application of items 701 to 723 and 732
Items 701 to 723 and 732 apply only to a service provided in the course of personal attendance by a single medical practitioner on a single patient.
2.17.10A Application of items in relation to items 721, 723 and 732
The following items do not apply to a service mentioned in the item that is provided by a medical practitioner, if the service is provided on the same day for the same patient for whom the practitioner provides a service mentioned 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 597, 598, 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.
2.17.11 Limitation on items 721, 723, 729, 731 and 732
(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 2.17.11.
Table 2.17.11—Limitation on items 721, 723, 729, 731 and 732
Item
Item of the table
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 multi‑disciplinary community care plan or a multi‑disciplinary 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 medical 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.
Group A15—GP management plans, team care arrangements and multidisciplinary care plans and case conferences
Item
Description
Fee ($)
Subgroup 1—GP management plans, team care arrangements and multidisciplinary care plans
721
Attendance by a medical practitioner (including a general practitioner, but 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)
144.25
723
Attendance by a medical practitioner (including a general practitioner, but 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)
114.30
729
Contribution by a medical practitioner (including a general practitioner, but 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)
70.40
731
Contribution by a medical practitioner (including a general practitioner, but 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)
70.40
732
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to review or coordinate a review of:
(a) a GP management plan prepared by a medical practitioner (or an associated medical practitioner) to which item 721 applies; or
(b) team care arrangements which have been coordinated by the medical practitioner (or an associated medical practitioner) to which item 723 applies
72.05
Subdivision C—Subgroup 2 of Group A15
2.17.12 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.
2.17.13 Meaning of multidisciplinary case conference in a residential aged care facility
In items 735, 739, 743, 747, 750 and 758:
multidisciplinary case conference in a residential aged care facility means a multidisciplinary case conference carried out for a care recipient in a residential aged care facility.
2.17.14 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 1.1.2 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).
2.17.15 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 clause 1.1.2 and putting a copy of that record in the patient’s medical records.
2.17.16 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.
2.17.17 Meaning of case conference team
For item 880, a case conference team:
(a) includes a specialist, or consultant physician, in the practice of his or her 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 family carer of the patient; and
(c) may include the patient, a family carer of the patient or a medical practitioner.
Example: For 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.
2.17.18 Application of item 880
(1) Item 880 applies if:
(a) the attendance is by a specialist, or consultant physician, in the specialty of geriatric medicine or rehabilitation medicine; and
(b) the attendance is on a patient who:
(i) is an admitted patient of a hospital; and
(ii) is not a care recipient in a residential aged care facility; and
(iii) is being provided with one of the following types of specialist care:
(A) geriatric evaluation and management;
(B) 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.
Group A15—GP management plans, team care arrangements and multidisciplinary care plans and case conferences
Item
Description
Fee ($)
Subgroup 2—Case conferences
735
Attendance by a medical practitioner (including a general practitioner, but 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 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)
70.65
739
Attendance by a medical practitioner (including a general practitioner, but 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 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)
120.95
743
Attendance by a medical practitioner (including a general practitioner, but 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 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)
201.65
747
Attendance by a medical practitioner (including a general practitioner, but 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 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)
51.90
750
Attendance by a medical practitioner (including a general practitioner, but 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 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)
89.00
758
Attendance by a medical practitioner (including a general practitioner, but 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 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)
148.20
820
Attendance by a consultant physician in the practice of his or her 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
139.10
822
Attendance by a consultant physician in the practice of his or her 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
208.70
823
Attendance by a consultant physician in the practice of his or her 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
278.15
825
Attendance by a consultant physician in the practice of his or her specialty, as a member of a 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, with a multidisciplinary team of at least 2 other formal care providers of different disciplines
99.90
826
Attendance by a consultant physician in the practice of his or her specialty, as a member of a 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
159.30
828
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community 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
218.75
830
Attendance by a consultant physician in the practice of his or her 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
139.10
832
Attendance by a consultant physician in the practice of his or her 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
208.70
834
Attendance by a consultant physician in the practice of his or her 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
278.15
835
Attendance by a consultant physician in the practice of his or her 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
99.90
837
Attendance by a consultant physician in the practice of his or her 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
159.30
838
Attendance by a consultant physician in the practice of his or her 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
218.75
855
Attendance by a consultant physician in the practice of his or her specialty of psychiatry, 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 2 other formal care providers of different disciplines
139.10
857
Attendance by a consultant physician in the practice of his or her specialty of psychiatry, 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 2 other formal care providers of different disciplines
208.70
858
Attendance by a consultant physician in the practice of his or her specialty of psychiatry, 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 2 other formal care providers of different disciplines
278.15
861
Attendance by a consultant physician in the practice of his or her 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
139.10
864
Attendance by a consultant physician in the practice of his or her 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
208.70
866
Attendance by a consultant physician in the practice of his or her 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
278.15
871
Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), 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
80.30
872
Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), 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
37.40
880
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
48.65
Division 2.18—Group A17: Domiciliary and residential medication management reviews
2.18.1 Meaning of living in a community setting
For item 900, a patient is living in a community setting if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility.
2.18.2 Meaning of residential medication management review
(1) In item 903:
residential medication management review means a collaborative service provided by a medical practitioner and a pharmacist to review the medication management needs of a permanent resident of a residential aged care facility.
(2) A medical 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 post‑review discussion (either face‑to‑face 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 follow‑up;
(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 medical 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 post‑review 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 medical practitioner agree that issues arising out of the review should be considered in a case conference.
2.18.3 Application of items 900 and 903
Items 900 and 903 apply only to a service provided in the course of personal attendance by a single medical practitioner on a single patient.
Group A17—Domiciliary medication management review
Item
Description
Fee ($)
900
Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for patients living in a community setting, in which the medical practitioner:
(a) assesses a patient’s medication management needs and, following that assessment, refers the patient to a community pharmacy or an accredited pharmacist for a DMMR and, with the patient’s consent, provides relevant clinical information required for the review; and
(b) discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and
(c) develops a written medication management plan following discussion with 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
154.80
903
Participation by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) in a residential medication management review (RMMR) for a patient who is a permanent resident of 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
106.00
Division 2.18A—Group A30: Medical practitioner video conferencing consultation
2.18A.1 Application of items
(1) An item in Group A30 may be claimed if:
(a) the service described in the item is undertaken in association with a service described in an item mentioned in sub‑clause (2); and
(b) no other service described in an item in Group A30 is provided to the patient on the same occasion.
(2) For subclause (1), the items are 99, 112, 113, 114, 149, 288, 384, 389, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.
2.18A.2 Application of 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 care service if the patient is a care recipient.
2.18A.3 Meaning of amount under clause 2.18A.3
An amount under clause 2.18A.3, for an item mentioned in column 1 of table 2.18A.3, means the sum of:
(a) the fee for the item mentioned in column 2 of the 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 the 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 the table.
Table 2.18A.3—Amount under clause 2.18A.3
Item
Column 1
Item of the table
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 ($)
1
2122
The fee for item 2100
25.95
2.00
2
2125
The fee for item 2100
46.70
3.30
3
2137
The fee for item 2126
25.95
2.00
4
2138
The fee for item 2126
46.70
3.30
5
2147
The fee for item 2143
25.95
2.00
6
2179
The fee for item 2143
46.70
3.30
7
2199
The fee for item 2195
25.95
2.00
8
2220
The fee for item 2195
46.70
3.30
2.18A.4 Limitation of items
Items 2100, 2122, 2126, 2137, 2143, 2147, 2195 and 2199 do not apply if the patient or the specialist or consultant physician mentioned in paragraph (a) of the item travels to a place to satisfy the requirement:
(a) for items 2100, 2126, 2143 and 2195—in sub‑subparagraph (c)(i)(B) of the item; and
(b) for items 2122, 2137, 2147 and 2199—in subparagraph (d)(ii) of the item.
Group A30—Medical Practitioner (including a general practitioner, specialist or consultant physician) video conferencing consultation
Item
Description
Fee ($)
Subgroup 1—Video conferencing consultation attendance at consulting rooms, home visit or other institution
2100
Professional attendance at consulting rooms of at least 5 minutes in duration (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 kms 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
22.90
2122
Professional attendance not in consulting rooms of at least 5 minutes in duration (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 care service; and
(d) is located both:
(i) within a telehealth eligible area; and
(ii) at the time of the attendance—at least 15 kms 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 table 2.18A.3
2126
Professional attendance at consulting rooms of less than 20 minutes in duration (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 kms 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
49.95
2137
Professional attendance not in consulting rooms of less than 20 minutes in duration (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 care service; and
(d) is located both:
(i) within a telehealth eligible area; and
(ii) at the time of the attendance—at least 15 kms 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 table 2.18A.3
2143
Professional attendance at consulting rooms of at least 20 minutes in duration (whether or not continuous) by a medical practitioner who provides 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 kms 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
96.85
2147
Professional attendance not in consulting rooms of at least 20 minutes in duration (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 care service; and
(d) is located both:
(i) within a telehealth eligible area; and
(ii) at the time of the attendance—at least 15 kms 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 table 2.18A.3
2195
Professional attendance at consulting rooms of at least 40 minutes in duration (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 kms 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
142.50
2199
Professional attendance not in consulting rooms of at least 40 minutes in duration (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 care service; and
(d) is located both:
(i) within a telehealth eligible area; and
(ii) at the time of the attendance—at least 15 kms 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 table 2.18A.3
Subgroup 2—Video conferencing consultation attendance at a residential aged care service
2125
Professional attendance of at least 5 minutes in duration (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 care service; and
(c) is not a resident of a self‑contained unit;
for an attendance on one or more patients at one place on one occasion—each patient
Amount under table 2.18A.3
2138
Professional attendance of less than 20 minutes in duration (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 care service; and
(c) is not a resident of a self‑contained unit;
for an attendance on one or more patients at one place on one occasion—each patient
Amount under table 2.18A.3
2179
Professional attendance of at least 20 minutes in duration (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 care service; and
(c) is not a resident of a self‑contained unit;
for an attendance on one or more patients at one place on one occasion—each patient
Amount under table 2.18A.3
2220
Professional attendance of at least 40 minutes in duration (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 care service; and
(c) is not a resident of a self‑contained unit;
for an attendance on one or more patients at one place on one occasion—each patient
Amount under table 2.18A.3
Division 2.19—Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies)
2.19.1 Application of Subgroup 2 of Groups A18 and A19
(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 mentioned 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;
(ha) at least one measurement of the patient’s estimated Glomerular Filtration Rate (eGFR);
(i) provision to the patient of self‑management education regarding diabetes;
(j) a review of the patient’s diet, and provision to the patient of information about appropriate dietary choices;
(k) a review of the patient’s level of physical activity, and provision to the patient of information about the appropriate level of physical activity;
(l) checking the patient’s tobacco smoking activity, and, if relevant, encouraging the patient to stop smoking;
(m) 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
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 Application of Subgroup 3 of Groups A18 and A19
(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 mentioned 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 asthma‑related 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 self‑management 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.
Group A18—General practitioner attendances associated with Practice Incentives Program (PIP) payments
Item
Description
Fee ($)
Subgroup 1—Taking of a cervical smear 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 cervical smear is taken from a person between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years
16.95
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 health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years
37.05
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 health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear 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 health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years
71.70
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 health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear 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 health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear in the last 4 years
105.55
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 health‑related issues, with appropriate documentation, and at which a papanicolaou smear is taken from a person at least 20 years old and not older than 69 years old, who has not had a papanicolaou smear 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 health‑related issues, with appropriate documentation, and completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
37.05
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 health‑related 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 health‑related issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
71.70
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 health‑related 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 health‑related issues, with appropriate documentation, and that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
105.55
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 health‑related 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 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 health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care
37.05
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 health‑related 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 health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care
71.70
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 health‑related 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 health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care
105.55
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;
Amount under clause 2.1.1
(e) providing appropriate preventive health care;
for one or more health‑related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care
Group A19—Other non‑referred attendances associated with Practice Incentives Program (PIP) payments to which no other item applies
Item
Description
Fee ($)
Subgroup 1—Taking of a cervical smear from an unscreened or significantly underscreened person
2598
Professional attendance at consulting rooms of less than 5 minutes in duration by a medical practitioner who practices in general practice (other than a general practitioner) at which a cervical smear is taken from a person between the ages of 20 and 69 years (inclusive) who has not had a cervical smear in the last 4 years
11.00
2600
Professional attendance at consulting rooms of more than 5, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years
21.00
2603
Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years
38.00
2606
Professional attendance at consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years
61.00
2610
Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years
Amount under clause 2.1.1
2613
Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years
Amount under clause 2.1.1
2616
Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a person between the ages of 20 and 69 (inclusive) who has not had a cervical smear 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 of more than 5 minutes, but not more than 25 minutes in duration 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 of more than 25 minutes, but not more than 45 minutes in duration 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 of more than 45 minutes in duration 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 of more than 5 minutes, but not more than 25 minutes in duration 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 of more than 25 minutes but not more than 45 minutes, in duration 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 of more than 45 minutes in duration 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 Asthma Cycle of Care
2664
Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes in duration 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 of more than 25 minutes, but not more than 45 minutes in duration 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 of more than 45 minutes in duration 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 of more than 5 minutes, but not more than 25 minutes in duration 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 of more than 25 minutes, but not more than 45 minutes in duration 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 of more than 45 minutes in duration 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 2.20—Group A20: Mental health care
2.20.1 Definitions
In this Division:
focussed psychological strategies means any of the following mental health care management strategies which have been derived from evidence‑based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy which involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy.
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 (ICD‑10, 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 the table
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
25.95
2.00
2
2727
The fee for item 2725
25.95
2.00
2.20.3 Meaning of preparation of a GP mental health treatment plan
(1) The preparation of a GP mental health treatment plan, for a patient, means each of the following:
(a) preparation of a written plan by a medical 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 (a)(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 medical 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
A review of a GP mental health treatment plan means a process by which a medical practitioner:
(a) reviews the matters mentioned in paragraph (a) of the definition of preparation of a GP mental health treatment plan in clause 2.20.3; 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) re‑administers the outcome measurement tool used in the assessment mentioned in subparagraph (1)(a)(i) of the definition of preparation of a GP mental health treatment plan in clause 2.20.3 (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 medical practitioner
associated medical practitioner means a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).
2.20.6 Application of Subgroup 1 of Group A20
(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 in‑patient (including a private in‑patient 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 medical practitioner on a single patient.
(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; or
(c) within 3 months following the provision of a service to which item 2712, or item 2719 of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (as in force on 29 February 2012), applies; or
(d) more than once in a 12 month period from the provision of a service to which item 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 (as in force on 31 October 2011) applies for the patient.
(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:
(i) items 2700, 2701, 2715 and 2717; or
(ii) items 2702 and 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 (as in force on 31 October 2011);
(b) a review of a GP mental health treatment plan under item 2712, or item 2719 of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (as in force on 29 February 2012);
(c) 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); or
(c) unless exceptional circumstances exist for the provision of the service to a patient within 3 months after the patient is provided a service to which item 2719 of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (as in force on 29 February 2012) applies.
(6) Item 2713 applies only:
(a) to a surgery consultation; and
(b) to an attendance of at least 20 minutes in duration.
(7) Item 2713 does not apply in association with a service to which item 2700, 2701, 2715, 2717 or 2712 applies.
(8) Items 2715 and 2717 apply only if the medical 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.
(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 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 medical practitioner:
(i) whose name is entered in the register maintained by the Chief Executive Medicare under regulation 30 of the Human Services (Medicare) Regulations 1975; and
(ii) who is identified in the register as a 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:
(i) for the period from 1 March 2012 to 31 December 2012—is provided to a patient who has already been provided, in the calendar year, with 10 (or if exceptional circumstances exist—16) 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; and
(ii) for each subsequent calendar year—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.
Group A20—Mental health care
Item
Description
Fee ($)
Subgroup 1—GP mental health treatment plans
2700
Professional attendance by a medical practitioner (including a general practitioner who has not undertaken mental health skills training, but not including a specialist or consultant physician) of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient
71.70
2701
Professional attendance by a medical practitioner (including a general practitioner who has not undertaken mental health skills training, but not including a specialist or consultant physician) of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient
105.55
2712
Professional attendance by a medical practitioner (not including a specialist or consultant physician) to review a GP mental health treatment plan which he or she, or an associated medical practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan
71.70
2713
Professional attendance by a medical practitioner (not including a specialist or consultant physician) in relation to a mental disorder and of at least 20 minutes in duration, 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
71.70
2715
Professional attendance by a medical practitioner (including a general practitioner who has undertaken mental health skills training, but not including a specialist or consultant physician) of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient
91.05
2717
Professional attendance by a medical practitioner (including a general practitioner who has undertaken mental health skills training, but not including a specialist or consultant physician) of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient
134.10
Subgroup 2—Focussed psychological strategies
2721
Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than 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
92.75
2723
Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than 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 medical practitioner who practises in general practice (other than 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
132.75
2727
Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than 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 2.21—Group A24: Palliative and pain medicine
2.21.1 Meaning of organise and coordinate
In the items mentioned 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 1.1.2 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 1.1.2 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 Application of Group A24
(1) Subgroups 1 and 2 of Group A24 apply only if the attendance is by a medical practitioner who is recognised as a specialist, or consultant physician, in the specialty of pain medicine for the purposes of the Act.
(2) Subgroups 3 and 4 of Group A24 apply only if the attendance is by a medical practitioner who is recognised as a specialist, or consultant physician, in the specialty of palliative medicine for the purposes of the Act.
2.21.4 Limitation on items
The items in Subgroups 2 and 4 of Group A24 may only apply to a patient 5 times in a 12 month period.
2.21.5 Limitation of items
Items 2799, 2820, 3003 and 3015 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:
(a) for items 2799 and 3003—sub‑subparagraph(c)(i)(B) of the item; and
(b) for items 2820 and 3015—sub‑subparagraph (d)(i)(B) of the item.
Group A24—Palliative and pain medicine
Item
Description
Fee ($)
Subgroup 1—Pain medicine attendances
2799
Initial professional attendance of 10 minutes or less in duration on a patient by a specialist or consultant physician practising in his or her 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 kms by road from the specialist or physician; or
(ii) is a care recipient in a residential care service; 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
113.20
2801
Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
150.90
2806
Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 2814 applies) after the first in a single course of treatment
75.50
2814
Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment
43.00
2820
Professional attendance on a patient by a specialist or consultant physician practising in his or her 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 kms by road from the specialist or physician; or
(ii) is a care recipient in a residential care service; 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 his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
183.10
2832
Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 2840 applies) after the first in a single course of treatment
110.75
2840
Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of pain medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment
79.75
Subgroup 2—Pain medicine case conferences
2946
Attendance by a specialist, or consultant physician, in the practice of his or her 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
139.10
2949
Attendance by a specialist, or consultant physician, in the practice of his or her 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
208.70
2954
Attendance by a specialist, or consultant physician, in the practice of his or her 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
278.15
2958
Attendance by a specialist, or consultant physician, in the practice of his or her 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
99.90
2972
Attendance by a specialist, or consultant physician, in the practice of his or her 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
159.30
2974
Attendance by a specialist, or consultant physician, in the practice of his or her 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
218.75
2978
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
139.10
2984
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
208.70
2988
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
278.15
2992
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
99.90
2996
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
159.30
3000
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
218.75
Subgroup 3—Palliative medicine attendances
3003
Initial professional attendance of 10 minutes or less in duration on a patient by a specialist or consultant physician practising in his or her 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 kms by road from the specialist or physician; or
(ii) is a care recipient in a residential care service; 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
113.20
3005
Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
150.90
3010
Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 3014 applies) after the first in a single course of treatment
75.50
3014
Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment
43.00
3015
Professional attendance on a patient by a specialist or consultant physician practising in his or her 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 kms by road from the specialist or physician; or
(ii) is a care recipient in a residential care service; 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 his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment
183.10
3023
Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 3028 applies) after the first in a single course of treatment
110.75
3028
Professional attendance at a place other than consulting rooms or hospital by a specialist, or consultant physician, in the practice of his or her specialty of palliative medicine following referral of the patient to him or her by a referring practitioner—each minor attendance after the first attendance in a single course of treatment
79.75
Subgroup 4—Palliative medicine case conferences
3032
Attendance by a specialist, or consultant physician, in the practice of his or her 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
139.10
3040
Attendance by a specialist, or consultant physician, in the practice of his or her 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
208.70
3044
Attendance by a specialist, or consultant physician, in the practice of his or her 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
278.15
3051
Attendance by a specialist, or consultant physician, in the practice of his or her 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
99.90
3055
Attendance by a specialist, or consultant physician, in the practice of his or her 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
159.30
3062
Attendance by a specialist, or consultant physician, in the practice of his or her 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
218.75
3069
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
139.10
3074
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
208.70
3078
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
278.15
3083
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
99.90
3088
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
159.30
3093
Attendance by a specialist, or consultant physician, in the practice of his or her 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)
218.75
Division 2.22—Group A27: Pregnancy support counselling
2.22.1 Application of item 4001
(1) A service to which item 4001 applies must not be provided by a medical 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:
non‑directive pregnancy support counselling means counselling provided by a medical practitioner to a person in which:
(a) information and issues relating to pregnancy are discussed; and
(b) the medical practitioner does not impose his or her 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 pregnancy‑related issue.
Group A27—Pregnancy support counselling
Item
Description
Fee ($)
4001
Professional attendance of at least 20 minutes in duration at consulting rooms by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a person who:
76.60
(a) is currently pregnant; or
(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 81000, 81005 or 81010 applies in relation to that pregnancy
Note: For items 81000, 81005 and 81010, see the determination about allied health services under subsection 3C(1) of the Act.
Division 2.23—Group A22: General practitioner after‑hours attendances to which no other item applies
2.23.1 Application of Group A22
(1) Items 5000, 5020, 5040 and 5060 apply only to a professional attendance that is provided:
(a) on a public holiday; or
(b) on a Sunday; or
(c) before 8 am, or after 1 pm, on a Saturday; or
(d) before 8 am, or after 8 pm, on a day other than a day mentioned in paragraphs (a) to (c).
(2) Items 5003, 5010, 5023, 5028, 5043, 5049, 5063 and 5067 apply only to a professional attendance that is provided in an after‑hours period.
Group A22—General practitioner after‑hours attendances to which no other item applies
Item
Description
Fee ($)
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—each attendance
29.00
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 the table 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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex, if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained 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 the table 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 health‑related issues, with appropriate documentation—each attendance
49.00
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 the table 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 health‑related 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 the table applies), at a residential aged care facility to residents of the 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 health‑related 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 the table 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 health‑related issues, with appropriate documentation—each attendance
83.95
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 the table 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 health‑related 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 at a residential aged care facility to residents of the facility (other than a service to which another item in the table 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 health‑related 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 the table 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 health‑related issues, with appropriate documentation—each attendance
117.75
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 the table 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 health‑related 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 at a residential aged care facility to residents of the facility (other than a service to which another item in the table 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 health‑related 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 2.24—Group A23: Other non‑referred after‑hours attendances to which no other item applies
2.24.1 Application of Group A23
(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 after‑hours period.
Group A23—Other non‑referred after‑hours attendances to which no other item applies
Item
Description
Fee ($)
5200
Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance
21.00
5203
Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance
31.00
5207
Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance
48.00
5208
Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which another item applies) by a medical practitioner (other than a general practitioner)—each attendance
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 the table 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 the table 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 the table 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 the table 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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of not more than 5 minutes in duration 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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes in duration 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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 25 minutes in duration 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 self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 45 minutes in duration 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 2.26—Group A26: Neurosurgery attendances to which no other item applies
2.26.1 Limitation of items 6004 and 6016
Items 6004 and 6016 do not apply if the patient or specialist travels to a place to satisfy the requirement in:
(a) for item 6004—sub‑subparagraph (c)(i)(B) of the item; and
(b) for item 6016—sub‑subparagraph (d)(i)(B) of the item.
Group A26—Neurosurgery attendances to which no other item applies
Item
Description
Fee ($)
6004
Initial professional attendance of 10 minutes or less in duration on a patient by a specialist practising in his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; 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
97.20
6007
Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at consulting rooms or hospital
129.60
6009
Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—a minor attendance after the first in a single course of treatment at consulting rooms or hospital
43.00
6011
Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance after the first 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 of more than 15 minutes in duration but not more than 30 minutes in duration at consulting rooms or hospital
85.55
6013
Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance after the first 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 of more than 30 minutes in duration but not more than 45 minutes in duration at consulting rooms or hospital
118.50
6015
Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her—an attendance after the first 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 of more than 45 minutes in duration at consulting rooms or hospital
150.90
6016
Professional attendance on a patient by a specialist practising in his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; 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 2.27—Group A9: Contact lenses
2.27.1 Application of 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.
Group A9—Contact lenses
Item
Description
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
121.65
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
121.65
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
121.65
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
121.65
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)
121.65
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
121.65
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
121.65
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
121.65
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
121.65
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
121.65
Division 2.28—Group A10: Optometric services provided by participating optometrist
2.28.1 Applications of items 10940 and 10941
(2) A service described in item 10940 applies to a patient not more than twice in a 12 month period and includes a service described in item 10941.
(3) A service described in item 10941 applies to a patient not more than twice in a 12 month period and includes a service described in item 10940.
2.28.2 Application of item 10929
Item 10929 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.
2.28.3 Limitation on items
(1) Item 10943 may only apply to a patient once in a 12 month period.
(2) Item 10942 may only apply to a patient twice in a 12 month period.
(3) Items 10921 to 10929 may only apply to a patient once in a 36 month period.
2.28.4 Application of items 10931, 10932 and 10933
(1) If item 10931, 10932 or 10933 applies, the fee mentioned in that item applies in addition to the fee mentioned in another item in the table that applies to the service.
(3) In items 10931, 10932 and 10933:
bulk‑billed, for a medical service, means:
(a) a medicare benefit is payable to a person in relation to the service; and
(b) under an agreement entered into under section 20A of the Act:
(i) the person assigns, to the practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and
(ii) the practitioner accepts the assignment in full payment of his or her fee for the service provided.
2.28.5 Limitation of item 10943
A service described in item 10943 does not apply to a service used to assess learning difficulties or learning disabilities.
2.28.6 Meaning of old item 10900
In the items in Group A10:
old item 10900 means item 10900 of the table as it was in force at any time before its repeal by Part 1 of Schedule 1 to the Health Insurance Legislation Amendment (Optometric Services and Other Measures) Regulation 2014.
Group A10—Optometric services provided by participating optometrist
Item
Description
Fee ($)
10905
Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has been referred by another optometrist who is not associated with the optometrist to whom the patient is referred
66.80
10907
Professional attendance of more than 15 minutes in duration, being the first in a course of attention if the patient has attended another optometrist for an attendance to which this item or item 10905, 10910, 10911, 10912, 10913, 10914 or 10915 applies, or to which old item 10900 applied:
(a) for a patient who is less than 65 years of age—within the previous 36 months; or
(b) for a patient who is at least 65 years of age—within the previous 12 months
33.45
10910
Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:
(a) the patient is less than 65 years of age; and
(b) the patient has not, within the previous 36 months, received a service to which:
(i) this item or item 10905, 10907, 10912, 10913, 10914 or 10915 applies; or
(ii) old item 10900 applied
66.80
10911
Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if:
(a) the patient is at least 65 years of age; and
(b) the patient has not, within the previous 12 months, received a service to which:
(i) this item, or item 10905, 10907, 10910, 10912, 10913, 10914 or 10915 applies; or
(ii) old item 10900 applied
66.80
10912
Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has suffered a significant change of visual function requiring comprehensive reassessment:
(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:
(i) this item, or item 10905, 10907, 10910, 10913, 10914 or 10915 at the same practice applies; or
(ii) old item 10900 at the same practice applied; or
(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:
(i) this item, or item 10905, 10907, 10910, 10911, 10913, 10914 or 10915 at the same practice applies; or
(ii) old item 10900 at the same practice applied
66.80
10913
Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has new signs or symptoms, unrelated to the earlier course of attention, requiring comprehensive reassessment:
(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:
(i) this item, or item 10905, 10907, 10910, 10912, 10914 or 10915 at the same practice applies; or
(ii) old item 10900 at the same practice applied; or
(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:
(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10914 or 10915 at the same practice applies; or
(ii) old item 10900 at the same practice applied
66.80
10914
Professional attendance of more than 15 minutes in duration, being the first in a course of attention, if the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment:
(a) for a patient who is less than 65 years of age—within 36 months of an initial consultation to which:
(i) this item, or item 10905, 10907, 10910, 10912, 10913 or 10915 applies; or
(ii) old item 10900 applied; or
(b) for a patient who is at least 65 years of age—within 12 months of an initial consultation to which:
(i) this item, or item 10905, 10907, 10910, 10911, 10912, 10913 or 10915 applies; or
(ii) old item 10900 applied
66.80
10915
Professional attendance of more than 15 minutes in duration, being the first in a course of attention involving the examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus, requiring comprehensive reassessment
66.80
10916
Professional attendance, being the first in a course of attention, of not more than 15 minutes in duration (other than a service associated with a service to which item 10931, 10932, 10933, 10940, 10941, 10942 or 10943 applies)
33.45
10918
Professional attendance, being the second or subsequent in a course of attention and being unrelated to the prescription and fitting of contact lenses (other than a service associated with a service to which item 10940 or 10941 applies)
33.45
10921
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients with myopia of 5.0 dioptres or greater (spherical equivalent) in one eye
165.80
10922
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in one eye
165.80
10923
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients with astigmatism of 3.0 dioptres or greater in one eye
165.80
10924
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients 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
209.20
10925
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)
165.80
10926
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a contact lens is prescribed as part of a telescopic system
165.80
10927
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients 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
209.20
10928
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients who, because of physical deformity, are unable to wear spectacles
165.80
10929
All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention for which the first attendance is a service to which:
(a) item 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915 or 10916 applies; or
(b) old item 10900 applied
For patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10926, 10927 or 10928 applies) requiring the use of a contact lens for correction, if the condition is specified on the patient’s account
209.20
10930
All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses if the patient meets the requirements of an item in the series 10921 to 10929 and requires a change in contact lens material or basic lens parameters, other than a simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens covered by items 10921 to 10929
165.80
10931
A service to which an item in Group A10 applies (other than this item or item 10916, 10932, 10933, 10940 or 10941), if the service:
(a) is provided:
(i) during a home visit to a person; or
(ii) in a residential aged care facility; or
(iii) in an institution; and
(b) is provided to a single patient at a single location on a single occasion; and
(c) is:
(i) bulk‑billed for the fees for this item and another item in the table applying to the service; or
(ii) not bulk‑billed for the fees for this item and another item in the table applying to the service
23.30
10932
A service to which an item in Group A10 applies (other than this item or item 10916, 10931, 10933, 10940 or 10941), if the service:
(a) is provided:
(i) during a home visit to a person; or
(ii) in a residential aged care facility; or
(iii) in an institution; and
(b) is provided to each of 2 patients at a single location on a single occasion; and
(c) is:
(i) bulk‑billed for the fees for this item and another item in the table applying to the service; or
(ii) not bulk‑billed for the fees for this item and another item in the table applying to the service
11.60
10933
A service to which an item in Group A10 applies (other than this item or item 10916, 10931, 10932, 10940 or 10941), if the service:
(a) is provided:
(i) during a home visit to a person; or
(ii) in a residential aged care facility; or
(iii) in an institution; and
(b) is provided to each of 3 patients at a single location on a single occasion; and
(c) is:
(i) bulk‑billed for the fees for this item and another item in the table applying to the service; or
(ii) not bulk‑billed for the fees for this item and another item in the table applying to the service
7.70
10940
Full quantitative computerised perimetry (automated absolute static threshold), with bilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:
(a) is not a service involving multifocal multichannel objective perimetry; and
(b) is performed by an optometrist;
other than a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies
63.75
10941
Full quantitative computerised perimetry (automated absolute static threshold) with unilateral assessment and report, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain that:
(a) is not a service involving multifocal multichannel objective perimetry; and
(b) is performed by an optometrist;
other than a service associated with a service to which item 10916, 10918 10931, 10932 or 10933 applies
38.45
10942
Testing of residual vision to provide optimum visual performance for a patient who has best corrected visual acuity of 6/15 or N.12 or worse in the better eye or a horizontal visual field of less than 120 degrees and within 10 degrees above and below the horizontal midline, involving one or more of the following:
(a) spectacle correction;
(b) determination of contrast sensitivity;
(c) determination of glare sensitivity;
(d) prescription of magnification aids;
other than a service associated with a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies
33.45
10943
Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant binocular or accommodative dysfunction, in a patient aged 3 to 14 years, including assessment of one or more of the following:
(a) accommodation;
(b) ocular motility;
(c) vergences;
(d) fusional reserves;
(e) cycloplegic refraction;
other than a service to which item 10916, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929 or 10930 applies
33.45
Division 2.29—Miscellaneous services
Note: Reserved for future use.
Division 2.30—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
2.30.1 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.
2.30.2 Application of item 10986
(1) For item 10986, the only health assessment that may be provided is a Healthy Kids Check, in accordance with clause 2.16.4 for a patient if the patient is:
(a) at least 3 years old and under 5 years old; and
(b) receiving or has received the immunisation recommended for a 4 year old child; and
(c) not an in‑patient of a hospital.
(2) Item 10986 applies only if:
(a) the practice nurse or Aboriginal and Torres Strait Islander health practitioner providing the assessment is appropriately qualified and trained to perform the services provided; and
(b) the medical practitioner under whose supervision the treatment is provided retains responsibility for clinical outcomes and for the health and safety of the patient.
(3) A Healthy Kids Check, in accordance with clause 2.16.4, provided under item 10986:
(a) must not be provided more than once to an eligible person; and
(b) must not be provided to a patient who has previously received a Healthy Kids Check, in accordance with clause 2.16.4, under item 701, 703, 705 or 707.
2.30.3 Restrictions on item 10986
(1) A health assessment mentioned in clause 2.30.2 must not include a health screening service.
(2) A separate consultation must not be conducted in conjunction with a health assessment unless clinically necessary.
(3) In this clause:
health screening service has the same meaning as in subsection 19(5) of the Act.
2.30.4 Application of 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.
2.30.5 Application of 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.
2.30.6 Limitation of item 10983
Item 10983 does not apply if the patient or the specialist or consultant physician mentioned in paragraph (a) of the item travels to a place to satisfy the requirement in sub‑subparagraph (c)(i)(B) of the item.
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
Item
Description
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 kms 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
32.40
Subgroup 2—Video conferencing consultation support service provided at a residential care service, 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 care service; and
(c) is not a resident of a self‑contained unit
32.40
Subgroup 3—Services provided by a practice nurse or an Aboriginal and Torres
Strait Islander health practitioner on behalf of a medical practitioner
10986
A Healthy Kids Check in accordance with clause 2.16.4 provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner for a patient who is receiving or has received the immunisation recommended for a 4 year old child if:
(a) the Healthy Kids Check is provided on behalf of, and under the supervision of, a medical practitioner (including a general practitioner, but not including a specialist or consultant physician); and
(b) the patient is not an in‑patient of a hospital
58.20
10987
Follow‑up 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
24.00
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
12.00
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
12.00
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 each patient 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
12.00
Division 2.31—Group M1: Management of bulk‑billed services
2.31.1 Definitions for Division 2.31
In this Division:
ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2010, published by the Australian Bureau of Statistics, as in force on 16 September 2010.
bulk‑billed, for a medical service, means:
(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, his or her right to the payment of the medicare benefit; and
(ii) the medical practitioner accepts the assignment in full payment of his or her fee for the service provided.
Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84(1) of the National Health Act 1953.
eligible area means:
(a) a regional, rural or remote area; or
(b) Tasmania; or
(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) Gosford‑Wyong;
(viii) Greater Geelong City Part A;
(ix) Gungahlin‑Hall;
(x) Ipswich City (Part in BSD);
(xi) Litchfield Shire;
(xii) Melton‑Wyndham;
(xiii) Mornington Peninsula Shire;
(xiv) Newcastle;
(xv) North Canberra;
(xvi) Palmerston‑East 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 Creek‑Stromlo;
(xxvii) Woden Valley;
(xxviii) Yarra Ranges Shire Part A; or
(d) the geographical area included in the SLA spatial unit of Palm Island (AC).
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.
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 to a person by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.
2.31.2 Application of 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 the table that applies to the service.
Group M1—Management of bulk‑billed services
Item
Description
Fee ($)
10990
A medical service to which an item in the table (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 Commonwealth concession card holder; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk‑billed in relation to the fees for:
(i) this item; and
(ii) the other item in the table applying to the service
7.20
10991
A medical service to which an item in the table (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 Commonwealth concession card holder; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk‑billed in relation to the fees for:
(i) this item; and
(ii) the other item in the table applying to the service; and
(e) the service is provided at, or from, a practice location in an eligible area
10.85
10992
A medical service to which item 597, 598, 599, 600, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 or 5267 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 Commonwealth concession card holder; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is not provided in consulting rooms; and
(e) the service is provided in an eligible area; and
(f) the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an eligible area; and
(g) the service is bulk‑billed in relation to the fees for:
(i) this item; and
(ii) the other item in the table applying to the service
10.85
Division 2.33—Diagnostic procedures and investigations
Note: Reserved for future use.
Division 2.34—Group D1: Miscellaneous diagnostic procedures and investigations
2.34.1 Meaning of report
In this Division:
report means a report prepared by a medical practitioner.
2.34.2 Meaning of qualified sleep medicine practitioner
(1) In items 12203, 12207, 12213 and 12217:
qualified sleep medicine practitioner means a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner.
(1A) In items 12210 and 12215:
qualified sleep medicine practitioner:
(a) means a qualified paediatric sleep medicine practitioner; and
(b) does not include a qualified adult sleep medicine practitioner.
(1AA) In item 12250:
qualified sleep medicine practitioner:
(a) means a qualified adult sleep medicine practitioner; and
(b) does not include a qualified paediatric sleep medicine practitioner.
(2) A person is a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner if:
(a) the person has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, sufficient training and experience in the relevant field of sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; or
(b) the person:
(i) has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, substantial training or experience in adult sleep medicine, but requiring further specified training or experience in the relevant field of sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; and
(ii) either:
(A) the period of 2 years immediately following that assessment has not expired; or
(B) the person has been assessed by the Credentialling Subcommittee as having satisfactorily finished the further training or gained the further experience specified for that person; or
(c) the person has attained Level I or Level II of the relevant Advanced Training Program of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association, after having completed at least 12 months core training, including clinical practice in the relevant field of sleep medicine and in reporting sleep studies; or
(d) the Advisory Committee has recognised the person, in writing, as having training equivalent to the training mentioned in paragraph (c).
(3) In this clause:
Advisory Committee means the Specialist Advisory Committee in Thoracic and Sleep Medicine of the Royal Australasian College of Physicians.
Appeal Committee means the Appeal Committee of the Royal Australasian College of Physicians.
Credentialling Subcommittee means the Credentialling Subcommittee of the Advisory Committee.
relevant Advanced Training Program means:
(a) for an assessment for qualification as a qualified adult sleep medicine practitioner—the Advanced Training Program in Adult Sleep Medicine; or
(b) for an assessment for qualification as a qualified paediatric sleep medicine practitioner—the Advanced Training Program in Paediatric Sleep Medicine.
relevant field of sleep medicine means:
(a) for an assessment for qualification as a qualified adult sleep medicine practitioner—adult sleep medicine; or
(b) for an assessment for qualification as a qualified paediatric sleep medicine practitioner—paediatric sleep medicine.
Group D1—Miscellaneous diagnostic procedures and investigations
Item
Description
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.)
123.10
11003
Electroencephalography, prolonged recording of at least 3 hours in duration, 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
325.70
11004
Electroencephalography, ambulatory or video, prolonged recording of at least 3 hours in duration up to 24 hours in duration, 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
325.70
11005
Electroencephalography, ambulatory or video, prolonged recording of at least 3 hours in duration up to 24 hours in duration, 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
325.70
11006
Electroencephalography, temporosphenoidal, other than a service involving quantitative topographic mapping using neurometrics or similar devices
167.00
11009
Electrocorticography
227.75
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)
112.00
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)
149.90
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)
223.95
11021
Neuromuscular electrodiagnosis—repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis or both of these examinations
149.90
11024
Central nervous system evoked responses, investigation of, by computerised averaging techniques, other than a service involving quantitative topographic mapping of event‑related potentials or involving multifocal multichannel objective perimetry—one or 2 studies
113.85
11027
Central nervous system evoked responses, investigation of, by computerised averaging techniques, other than a service involving quantitative topographic mapping of event‑related potentials or involving multifocal multichannel objective perimetry—3 or more studies
168.90
Subgroup 2—Ophthalmology
11200
Provocative test or tests for open angle glaucoma, including water drinking
40.80
11204
Electroretinography of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards
108.25
11205
Electrooculography of one or both eyes performed according to current professional guidelines or standards
108.25
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
108.25
11211
Dark adaptometry of one or both eyes with a quantitative estimation of threshold in log lumens at 45 minutes of dark adaptations
108.25
11215
Retinal photography, multiple exposures, of one eye with intravenous dye injection
123.00
11218
Retinal photography, multiple exposures of both eyes with intravenous dye injection
151.95
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 his or her 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 2 examinations (including examinations to which item 11224 applies) in any 12 month period
67.75
11222
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 his or her specialty, with assessment and report, bilateral, if it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11221 applies due to presence of one of the following conditions:
(a) established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;
(b) established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;
(c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;
each additional examination
67.75
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 his or her 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 2 examinations (including examinations to which item 11221 applies) in any 12 month period
40.85
11225
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 his or her specialty, with assessment and report, unilateral, if it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11224 applies due to presence of one of the following conditions:
(a) established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;
(b) established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;
(c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;
each additional examination
40.85
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 report
122.75
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
81.45
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
81.45
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
103.65
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
80.10
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
80.10
11244
Orbital contents, diagnostic B‑scan of, by a specialist practising in his or her 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
77.00
Subgroup 3—Otolaryngology
11300
Brain stem evoked response audiometry (Anaes.)
192.45
11303
Electrocochleography, extratympanic method, one or both ears
192.45
11304
Electrocochleography, transtympanic membrane insertion technique, one or both ears
316.95
11306
Non‑determinate audiometry
21.90
11309
Audiogram, air conduction
26.30
11312
Audiogram, air and bone conduction or air conduction and speech discrimination
37.15
11315
Audiogram, air and bone conduction and speech
49.20
11318
Audiogram, air and bone conduction and speech, with other cochlear tests
60.75
11321
Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff’s test)
115.35
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 his or her 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
32.85
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 his or her 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
19.75
11330
Impedance audiogram if the patient is not referred by a medical practitioner—one examination in any 4 week period
7.90
11332
Oto‑acoustic 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) intra‑uterine 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
58.55
11333
Caloric test of labyrinth or labyrinths
44.60
11336
Simultaneous bithermal caloric test of labyrinths
44.60
11339
Electronystagmography
44.60
Subgroup 4—Respiratory
11500
Bronchospirometry, including gas analysis
167.00
11503
Measurement of the:
(a) mechanical or gas exchange function of the respiratory system; or
(b) respiratory muscle function; or
(c) ventilatory control mechanisms
Various measurement parameters may be used including any of the following:
(a) pressures;
(b) volumes;
(c) flow;
(d) gas concentrations in inspired or expired air;
(e) alveolar gas or blood;
(f) electrical activity of muscles
The tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital. Each occasion at which one or more of such tests are performed, not being a service associated with a service to which item 22018 applies
138.65
11506
Measurement of respiratory function involving a permanently recorded tracing performed before and after inhalation of bronchodilator—each occasion at which one or more such tests are performed
20.55
11509
Measurement of respiratory function involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex respiratory function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital)—each occasion at which one or more such tests are performed
35.65
11512
Continuous measurement of the relationship between flow and volume during expiration or inspiration involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex lung function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital)—each occasion at which one or more such tests are performed
61.75
Subgroup 5—Vascular
11600
Central venous, pulmonary arterial, systemic arterial or cardiac intracavity blood pressure monitoring by indwelling catheter—once only for each type of pressure for a patient on a calendar day, other than a service:
(a) associated with the management of general anaesthesia; and
(b) to which item 13876 applies
69.30
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 or 32501 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
57.75
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 or 32501 applies
75.70
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 or 32501 applies
75.70
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
63.75
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
63.75
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
112.40
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
75.70
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
75.90
11627
Pulmonary artery pressure monitoring during open heart surgery, in a person under 12 years of age
228.65
Subgroup 6—Cardiovascular
11700
Twelve‑lead electrocardiography, tracing and report
31.25
11701
Twelve‑lead electrocardiography, report only if the tracing has been forwarded to another medical practitioner, not in association with a consultation on the same occasion
15.55
11702
Twelve‑lead electrocardiography, tracing only
15.55
11708
Continuous ECG recording of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in association with ambulatory blood pressure monitoring, involving microprocessor based analysis equipment, interpretation and report of recordings by a specialist physician or consultant physician
Not being a service to which item 11709 applies
The changing of a tape or batteries does not constitute a separate service. Where a recording is analysed and reported on and a decision is made to undertake a further period of monitoring, the second episode is regarded as a separate service
127.90
11709
Continuous ECG recording (Holter) of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in association with ambulatory blood pressure monitoring, utilising a system capable of superimposition and full disclosure printout of at least 12 hours of recorded ECG data, microprocessor based scanning analysis, with interpretation and report by a specialist physician or consultant physician
The changing of a tape or batteries does not constitute a separate service. Where a recording is analysed and reported on and a decision is made to undertake a further period of monitoring, the second episode is regarded as a separate service
167.45
11710
Ambulatory ECG monitoring, patient activated, single or multiple event recording, utilising a looping memory recording device which is connected continuously to the patient for 12 hours or more and is capable of recording for at least 20 seconds before each activation and for 15 seconds after each activation, including transmission, analysis, interpretation and report—payable once in any 4 week period
51.90
11711
Ambulatory ECG monitoring for 12 hours or more, patient activated, single or multiple event recording, utilising a memory recording device which is capable of recording for at least 30 seconds after each activation, including transmission, analysis, interpretation and report—payable once in any 4 week period
28.30
11712
Multi channel ECG monitoring and recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, involving the continuous attendance of a medical practitioner for not less than 20 minutes, with resting ECG, and with or without continuous blood pressure monitoring and the recording of other parameters, on premises equipped with mechanical respirator and defibrillator
152.15
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
69.75
11715
Blood dye—dilution indicator test
120.75
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 11700 or 11721 applies
34.75
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 11700 or 11718 applies
69.75
11722
Implanted ECG loop recording for the investigation of recurrent unexplained syncope if:
(a) a diagnosis has not been achieved through all other available cardiac investigations; and
(b) a neurogenic cause is not suspected; and
(c) the patient to whom the service is provided does not have a structural heart defect associated with a high risk of sudden cardiac death;
including reprogramming when required, retrieval of stored data, analysis, interpretation and report, other than a service to which item 38285 applies
34.75
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
168.90
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 11700, 11718 or 11721 applies
94.75
Subgroup 7—Gastroenterology and colorectal
11800
Oesophageal motility test, manometric
174.45
11810
Clinical assessment of gastro‑oesophageal reflux disease involving 24‑hour pH monitoring, including analysis, interpretation and report and including any associated consultation
174.45
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 patient to whom the service is provided:
(i) has recurrent or persistent bleeding; and
(ii) is anaemic or has active bleeding; 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 Recognition of Training in Gastrointestinal Endoscopy; and
(e) the service is not associated with balloon enteroscopy
2 039.20
11823
Capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with Peutz‑Jeghers 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
2 039.20
11830
Diagnosis of abnormalities of the pelvic floor involving anal manometry or measurement of anorectal sensation or measurement of the rectosphincteric reflex
186.80
11833
Diagnosis of abnormalities of the pelvic floor and sphincter muscles involving electromyography or measurement of pudendal and spinal nerve motor latency
249.75
Subgroup 8—Genito‑urinary physiological investigations
11900
Urine flow study including peak urine flow measurement, other than a service associated with a service to which item 11919 applies
27.55
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
111.10
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
111.10
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
165.15
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.)
165.15
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.)
165.15
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.)
428.35
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.)
428.35
11921
Bladder washout test for localisation of urinary infection—not including bacterial counts for organisms in specimens
75.05
Subgroup 9—Allergy testing
12000
Skin sensitivity testing for allergens, using one to 20 allergens, other than a service associated with a service to which item 12012, 12015, 12018 or 12021 applies
38.95
12003
Skin sensitivity testing for allergens, using more than 20 allergens, other than a service associated with a service to which item 12012, 12015, 12018 or 12021 applies
58.85
12012
Epicutaneous patch testing in the investigation of allergic dermatitis using less than the number of allergens included in a standard patch test battery
20.80
12015
Epicutaneous patch testing in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery
62.45
12018
Epicutaneous patch testing in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery and additional allergens to a total of up to and including 50 allergens
80.35
12021
Epicutaneous patch testing in the investigation of allergic dermatitis, performed by or on behalf of a specialist in the practice of his or her specialty, using more than 50 allergens
117.85
Subgroup 10—Other diagnostic procedures and investigations
12200
Collection of specimen of sweat by iontophoresis
37.20
12201
Administration, by a specialist or consultant physician in the practice of his or her specialty, of thyrotropin alfa‑rch (recombinant human thyroid‑stimulating hormone), and arranging services to which items 61426 and 66650 apply, for the detection of recurrent well‑differentiated 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 well‑differentiated thyroid cancer; and
(e) either:
(i) withdrawal from thyroid hormone therapy resulted in severe psychiatric disturbances when hypothyroid; or
(ii) withdrawal is medically contra‑indicated 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
2 392.90
12203
Overnight investigation for sleep apnoea for a period of at least 8 hours in duration, for a patient aged 18 years or more, if:
(a) continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation and ECG are performed; and
(b) a technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(c) the patient is referred by a medical practitioner; and
(d) the necessity for the investigation is determined by a qualified adult sleep medicine practitioner before the investigation; and
(e) polygraphic records are 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 stored for interpretation and preparation of report; and
(f) interpretation and report are provided by a qualified adult sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient
For any particular patient—applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period
588.00
12207
Overnight investigation for sleep apnoea for a period of at least 8 hours in duration, for a patient aged 18 years or more, if:
(a) continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation and ECG are performed; and
(b) a technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(c) the patient is referred by a medical practitioner; and
(d) the necessity for the investigation is determined by a qualified adult sleep medicine practitioner before the investigation; and
(e) polygraphic records are 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 stored for interpretation and preparation of report; and
(f) interpretation and report are provided by a qualified adult sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient;
if it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12203 applies for the adjustment or testing, or both, of the effectiveness of a positive pressure ventilatory support device (other than nasal continuous positive airway pressure) in sleep, in a patient with severe cardio‑respiratory failure, and if previous studies have demonstrated failure of continuous positive airway pressure or oxygen—each additional investigation
588.00
12210
Overnight paediatric investigation for a period of at least 8 hours in duration for a patient aged 12 years or less, if:
(a) continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end‑tidal or transcutaneous), oxygen saturation and ECG are performed; and
(b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(c) the patient is referred by a medical practitioner; and
(d) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(e) polygraphic records are 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 stored for interpretation and preparation of 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
701.85
12213
Overnight paediatric investigation for a period of at least 8 hours in duration for a patient aged between 12 and 18 years, if:
(a) recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end‑tidal or transcutaneous), oxygen saturation and ECG are performed; and
(b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(c) the patient is referred by a medical practitioner; and
(d) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(e) polygraphic records are 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 stored for interpretation and preparation of 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
632.30
12215
Overnight paediatric investigation for a period of at least 8 hours in duration for a patient aged 12 years or less, if:
(a) continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end‑tidal or transcutaneous), oxygen saturation and ECG are performed; and
(b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(c) the patient is referred by a medical practitioner; and
(d) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(e) polygraphic records are 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 stored for interpretation and preparation of 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;
if it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12210 applies, for the adjustment, or testing of the effectiveness, or both, of Continuous Positive Airway Pressure (CPAP) or of the bilevel pressure support or ventilation (or both), or if supplemental oxygen is required because of recurring hypoxia—each additional investigation
701.85
12217
Overnight paediatric investigation for a period of at least 8 hours in duration for a patient aged between 12 and 18 years, if:
(a) continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end‑tidal or transcutaneous), oxygen saturation and ECG are performed; and
(b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(c) the patient is referred by a medical practitioner; and
(d) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(e) polygraphic records are 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 stored for interpretation and preparation of report; and
(f) interpretation and report to be provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient;
if it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12213 applies, for the adjustment, or testing of the effectiveness, or both, of Continuous Positive Airway Pressure (CPAP) or of the bilevel pressure support or ventilation (or both), or if there is recurring hypoxia and supplemental oxygen is required—each additional investigation
632.30
12250
Overnight investigation for sleep apnoea for a period of at least 8 hours in duration for a patient aged 18 years or more, if all of the following requirements are met:
(a) the patient has, before the overnight investigation, been referred to a qualified sleep medicine practitioner by a medical practitioner whose clinical opinion is that there is a high probability that the patient has obstructive sleep apnoea;
(b) the investigation takes place after the qualified sleep medicine practitioner has:
(i) confirmed the necessity for the investigation; and
(ii) communicated this confirmation to the referring medical practitioner;
(c) during a period of sleep, the investigation involves recording a minimum of 7 physiological parameters which must include:
(i) continuous electro‑encephalogram (EEG); and
(ii) continuous electro‑cardiogram (ECG); and
(iii) airflow; and
(iv) thoraco‑abdominal movement; and
(v) oxygen saturation; and
(vi) 2 or more of the following:
(A) electro‑oculogram (EOG);
(B) chin electro‑myogram (EMG);
(C) body position;
(d) in the report on the investigation, the qualified sleep medicine practitioner uses the data specified in paragraph (c) to:
(i) analyse sleep stage, arousals and respiratory events; and
(ii) assess clinically significant alteration in heart rate;
(e) the qualified sleep medicine practitioner:
(i) before the investigation takes place, establishes quality assurance procedures for data acquisition; and
(ii) personally analyses the data and writes the report on the results of the investigation;
335.30
(f) the investigation is not provided to the patient on the same occasion as a service mentioned in any of items 11000 to 11005, 11503, 11700 to 11709, 11713 and 12203 is provided to the patient
Payable only once in a 12 month period
Division 2.35—Group D2: Nuclear medicine (non‑imaging)
2.35.1 Application of Group D2
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.
Group D2—Nuclear medicine (non‑imaging)
Item
Description
Fee ($)
12500
Blood volume estimation
216.65
12503
Erythrocyte radioactive uptake survival time test or iron kinetic test
424.75
12506
Gastrointestinal blood loss estimation involving examination of stool specimens
303.30
12509
Gastrointestinal protein loss
216.65
12512
Radioactive B12 absorption test—one isotope
105.05
12515
Radioactive B12 absorption test—2 isotopes
229.85
12518
Thyroid uptake (using probe)
105.05
12521
Perchlorate discharge study
126.65
12524
Renal function test (without imaging procedure)
158.35
12527
Renal function test (with imaging and at least 2 blood samples)
84.95
12530
Whole body count—other than a service associated with a service to which another item applies
126.65
12533
Carbon‑labelled urea breath test using oral C‑13 or C‑14 urea, performed by a specialist or consultant physician, including the measurement of exhaled 13CO2 or 14CO2, for either:
(a) the confirmation of Helicobactor pylori colonisation; or
(b) the monitoring of the success of eradication of Helicobactor pylori in patients with peptic ulcer disease;
(other than a service associated with a service to which item 66900 applies)
84.65
Division 2.37—Group T1: Miscellaneous therapeutic procedures
2.37.1 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 24‑hour 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.
2.37.2 Meaning of embryology laboratory services
For 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.
2.37.3 Meaning of treatment cycle
In clause 2.37.4 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 mentioned 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).
2.37.4 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 mentioned 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 mentioned 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 mentioned in that item.
2.37.5 Application of items 13020 to 14245
Items 13020 to 14245 do not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
2.37.6 Limitation on item 13104
Item 13104 is not applicable to a patient more than 12 times in a 12 month period.
2.37.7 Items relating to assisted reproductive services not to apply in certain pregnancy‑related 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.
2.37.8 Application of items 14227 to 14242
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.
2.37.9 Application of item 14245
(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 only on any calendar day.
2.37.10 Limitation of item 13210
Item 13210 does not apply if the patient or specialist
travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
Group T1—Miscellaneous therapeutic procedures
Item
Description
Fee ($)
Subgroup 1—Hyperbaric oxygen therapy
13015
Hyperbaric oxygen therapy, for treatment of localised non‑neurological soft tissue radiation injuries excluding radiation‑induced 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
254.75
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
258.85
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)
115.70
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 life‑saving emergency treatment, including any associated attendance—per hour (or part of an hour)
163.45
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
136.65
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
71.20
13104
Planning and management of home dialysis (haemodialysis or peritoneal dialysis) for a patient with end‑stage renal disease and supervision of the patient on self‑administered dialysis, if the attendance is by a consultant physician in the practice of his or her specialty of renal medicine
147.95
13106
Declotting of an arteriovenous shunt
121.35
13109
Indwelling peritoneal catheter (Tenckhoff or similar) for dialysis—insertion and fixation of (Anaes.)
227.75
13110
Tenckhoff peritoneal dialysis catheter, removal of (including catheter cuffs) (Anaes.)
228.50
13112
Peritoneal dialysis, establishment of, by abdominal puncture and insertion of temporary catheter (including associated consultation) (Anaes.)
136.65
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
3 110.75
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
2 909.75
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
465.55
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
486.75
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
465.55
13209
Planning and management of a referred patient by a specialist for the purpose of treatment by assisted reproductive technologies or for artificial insemination payable once only during one treatment cycle
84.70
13210
Professional attendance on a patient by a specialist practising in his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; 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.)
354.45
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.)
111.10
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.)
793.55
13221
Preparation of semen for the purpose of artificial insemination—only if rendered in connection with a service to which item 13203 applies
50.80
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
417.95
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 electro‑ejaculation device including catheterisation and drainage of bladder if required
204.25
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 electro‑ejaculation device including catheterisation and drainage of bladder if required, under general anaesthetic (H) (Anaes.)
408.70
Subgroup 4—Paediatric and neonatal
13300
Umbilical or scalp vein catheterisation in a neonate with or without infusion or cannulation of a vein
56.95
13303
Umbilical artery catheterisation with or without infusion
84.40
13306
Blood transfusion with venesection and complete replacement of blood, including collection from donor
334.10
13309
Blood transfusion with venesection and complete replacement of blood, using blood already collected
284.85
13312
Blood for pathology test, collection of, by femoral or external jugular vein puncture in infants
28.45
13318
Central vein catheterisation by open exposure, in a person under 12 years of age (Anaes.)
227.45
13319
Central vein catheterisation in a neonate via peripheral vein (Anaes.)
227.45
Subgroup 5—Cardiovascular
13400
Restoration of cardiac rhythm by electrical stimulation (cardioversion), other than in the course of cardiac surgery (Anaes.)
96.80
Subgroup 6—Gastroenterology
13500
Gastric hypothermia by closed circuit circulation of refrigerant in the absence of gastrointestinal haemorrhage
180.30
13503
Gastric hypothermia by closed circuit circulation of refrigerant for upper gastrointestinal haemorrhage
360.70
13506
Gastro‑oesophageal balloon intubation for control of bleeding from gastric oesophageal varices
184.50
Subgroup 8—Haematology
13700
Harvesting of homologous (including allogeneic) or autologous bone marrow for the purpose of transplantation (Anaes.)
333.25
13703
Transfusion of blood including collection from donor
119.50
13706
Transfusion of blood or bone marrow already collected
83.35
13709
Collection of blood for autologous transfusion or when homologous blood is required for immediate transfusion in emergency situation
48.45
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
136.65
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
136.65
13757
Therapeutic venesection for the management of haemochromatosis, polycythemia vera or porphyria cutanea tarda
72.95
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 non‑Hodgkin’s lymphoma at high risk of relapse following first line chemotherapy; or
(b) Hodgkin’s 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
762.60
Subgroup 9—Procedures associated with intensive care and cardiopulmonary
support
13815
Central vein catheterisation by percutaneous or open exposure other than a service to which item 13318 applies (Anaes.)
85.25
13818
Right heart balloon catheter, insertion of, including pulmonary wedge pressure and cardiac output measurement (Anaes.)
113.70
13830
Intracranial pressure, monitoring of, by intraventricular or subdural catheter, subarachnoid bolt or similar, by a specialist or consultant physician—each day
75.35
13839
Arterial puncture and collection of blood for diagnostic purposes
23.05
13842
Intra‑arterial cannulation for the purpose of taking multiple arterial blood samples for blood gas analysis
69.30
13847
Counterpulsation by intra‑aortic balloon management, on first day, including initial and subsequent consultations and monitoring of parameters (Anaes.)
156.10
13848
Counterpulsation by intra‑aortic balloon‑management on each day after the first, including associated consultations and monitoring of parameters
131.05
13851
Circulatory support device, management of, on first day
493.65
13854
Circulatory support device, management of, on each day after the first
114.85
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
146.40
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)
362.10
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)
268.60
13876
Central venous pressure, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure—once only for each type of pressure for a patient on a calendar day:
(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)
76.90
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)
146.40
13882
Ventilatory support in an intensive care unit, management of a patient:
(a) by:
(i) invasive means; or
(ii) non‑invasive means, if the only alternative to non‑invasive 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)
115.25
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)
153.65
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)
76.90
Subgroup 11—Chemotherapeutic procedures
13915
Cytotoxic chemotherapy, administration of, either by intravenous push technique (directly into a vein, or a butterfly needle, or the side‑arm of an infusion) or by intravenous infusion of not more than 1 hour in duration, 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
65.05
13918
Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 1 hour in duration but not more than 6 hours in duration—for any particular patient, once only on the same day
97.95
13921
Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 6 hours in duration—for the first day of treatment
110.80
13924
Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 6 hours in duration—on each day after the first in the same continuous treatment episode
65.25
13927
Cytotoxic chemotherapy, administration of, either by intra‑arterial push technique (directly into an artery, a butterfly needle or the side‑arm of an infusion) or by intra‑arterial infusion of not more than 1 hour in duration—for any particular patient, once only on the same day
84.40
13930
Cytotoxic chemotherapy, administration of, by intra‑arterial infusion of more than 1 hour in duration but not more than 6 hours in duration—for any particular patient, once only on the same day
117.80
13933
Cytotoxic chemotherapy, administration of, by intra‑arterial infusion of more than 6 hours in duration—for the first day of treatment
130.70
13936
Cytotoxic chemotherapy, administration of, by intra‑arterial infusion of more than 6 hours in duration—on each day after the first in the same continuous treatment episode
85.15
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
97.95
13942
Ambulatory drug delivery device, loading of, with a cytotoxic agent or agents for the infusion of the agent or agents via the intravenous, intra‑arterial 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
65.25
13945
Long‑term implanted drug delivery device for cytotoxic chemotherapy, accessing of
52.50
13948
Cytotoxic agent, instillation of, into a body cavity
65.25
Subgroup 12—Dermatology
14050
PUVA therapy or UVB therapy administered in whole body cabinet (other than a service associated with a service to which item 14053 applies) including associated consultations other than an initial consultation
52.75
14053
PUVA therapy or UVB therapy administered to localised body areas in a hand and foot cabinet (other than a service associated with a service to which item 14050 applies) including associated consultations other than an initial consultation
52.75
14100
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of vascular lesions of the head or neck, if abnormality is visible from 3 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period (Anaes.)
152.50
14106
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of port wine stains, haemangiomas of infancy, café‑au‑lait macules and naevi of Ota, other than melanocytic naevi (common moles), if abnormality is visible from 3 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period—area of treatment up to 50 cm2 (Anaes.)
152.50
14109
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of port wine stains, haemangiomas of infancy, café‑au‑lait 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 items 14100 to 14118 and 30213 apply) in any 12 month period—area of treatment more than 50 cm2 and up to 100 cm2 (Anaes.)
187.35
14112
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of port wine stains, haemangiomas of infancy, café‑au‑lait 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 items 14100 to 14118 and 30213 apply) in any 12 month period—area of treatment more than 100 cm2 and up to 150 cm2 (Anaes.)
221.75
14115
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of port wine stains, haemangiomas of infancy, café‑au‑lait 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 items 14100 to 14118 and 30213 apply) in any 12 month period—area of treatment more than 150 cm2 and up to 250 cm2 (Anaes.)
256.50
14118
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of port wine stains, haemangiomas of infancy, café‑au‑lait 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 items 14100 to 14118 apply) in any 12 month period—area of treatment more than 250 cm2 (Anaes.)
325.75
14124
Laser photocoagulation using laser light within the wave length of 510‑1064 nm in the treatment of haemangiomas of infancy, including any associated consultation—if a seventhor subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period that commences on the date of the first session (Anaes.)
152.50
Subgroup 13—Other therapeutic procedures
14200
Gastric lavage in the treatment of ingested poison
59.80
14201
Poly‑L‑lactic 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
236.85
14202
Poly‑L‑lactic 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
119.90
14203
Hormone or living tissue implantation, by direct implantation involving incision and suture (Anaes.)
51.15
14206
Hormone or living tissue implantation—by cannula
35.60
14209
Intra‑arterial infusion or retrograde intravenous perfusion of a sympatholytic agent
88.70
14212
Intussusception, management of fluid or gas reduction for (Anaes.)
185.30
14218
Implanted infusion pump, refilling of reservoir with a therapeutic agent or agents for infusion to the subarachnoid or epidural space, with or without re—programming a programmable pump, for the management of chronic intractable pain
97.95
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
52.50
14224
Electroconvulsive therapy, with or without the use of stimulus dosing techniques, including any electroencephalographic monitoring and associated consultation (Anaes.)
70.35
14227
Implanted infusion pump, refilling of reservoir with baclofen for infusion to the subarachnoid or epidural space, with or without re‑programming a programmable pump, for the management of severe chronic spasticity
97.95
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.)
298.05
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.)
361.90
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.)
659.95
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.)
159.40
14242
Subcutaneous reservoir and spinal catheter, insertion of, for the management of severe chronic spasticity (H) (Anaes.)
473.65
14245
Immunomodulating agent, administration of, by intravenous infusion for at least 2 hours in duration
97.95
Division 2.38—Group T2: Radiation oncology
2.38.1 Meaning of amount under clause 2.38.1
In an item of the table mentioned in column 1 of table 2.38.1:
amount under clause 2.38.1 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 2.38.1—Amount under clause 2.38.1
Item
Column 1
Item of
the table
Column 2
Fee
Column 3
Amount for each field separately treated in excess of one ($)
1
15003
The fee for item 15000
17.10
2
15009
The fee for item 15006
18.55
3
15103
The fee for item 15100
18.80
4
15109
The fee for item 15106
22.70
5
15115
The fee for item 15112
47.30
6
15214
The fee for item 15211
31.90
7
15230
The fee for item 15215
37.95
8
15233
The fee for item 15218
37.95
9
15236
The fee for item 15221
37.95
10
15239
The fee for item 15224
37.95
11
15242
The fee for item 15227
37.95
12
15260
The fee for item 15245
37.95
13
15263
The fee for item 15248
37.95
14
15266
The fee for item 15251
37.95
15
15269
The fee for item 15254
37.95
16
15272
The fee for item 15257
37.95
2.38.2 Meaning of approved site
In item 15338:
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.
2.38.3 Application of Group T2
Items 15000 to 15600 do 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 post‑surgical pain management.
2.38.4 Application of items 15556, 15559 and 15562
A service mentioned 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.
Group T2—Radiation oncology
Item
Description
Fee ($)
Subgroup 1—Superficial
15000
Radiotherapy, superficial (including treatment with x‑rays, radium rays or other radioactive substances), other than a service to which another item in this Group applies—each attendance at which fractionated treatment is given—one field
42.55
15003
Radiotherapy, superficial (including treatment with x‑rays, radium rays or other radioactive substances), other than a service to which another item in this Group applies—each attendance at which fractionated treatment is given—2 or more fields up to a maximum of 5 additional fields
Amount under clause 2.38.1
15006
Radiotherapy, superficial—attendance at which a single dose technique is applied—one field
94.35
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 2.38.1
15012
Radiotherapy, superficial—each attendance at which treatment is given to an eye
53.45
Subgroup 2—Orthovoltage
15100
Radiotherapy, deep or orthovoltage—each attendance at which fractionated treatment is given at 3 or more treatments per week—one field
47.70
15103
Radiotherapy, deep or orthovoltage—each 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 2.38.1
15106
Radiotherapy, deep or orthovoltage—each attendance at which fractionated treatment is given at 2 treatments per week or less frequently—one field
56.30
15109
Radiotherapy, deep or orthovoltage—each 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 2.38.1
15112
Radiotherapy, deep or orthovoltage—attendance at which a single dose technique is applied—one field
120.25
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 2.38.1
Subgroup 3—Megavoltage
15211
Radiation oncology treatment, using cobalt unit or caesium teletherapy unit—each attendance at which treatment is given—one field
54.70
15214
Radiation oncology treatment, using cobalt unit or caesium teletherapy unit—each 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 2.38.1
15215
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each attendance at which treatment is given—one field—treatment delivered to primary site (lung)
59.65
15218
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each attendance at which treatment is given—one field—treatment delivered to primary site (prostate)
59.65
15221
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each attendance at which treatment is given—one field—treatment delivered to primary site (breast)
59.65
15224
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each 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
59.65
15227
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each attendance at which treatment is given—one field—treatment delivered to secondary site
59.65
15230
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each 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 2.38.1
15233
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each 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 2.38.1
15236
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each 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 2.38.1
15239
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each 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 2.38.1
15242
Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities—each 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 2.38.1
15245
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each attendance at which treatment is given—one field—treatment delivered to primary site (lung)
59.65
15248
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each attendance at which treatment is given—one field—treatment delivered to primary site (prostate)
59.65
15251
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each attendance at which treatment is given—one field—treatment delivered to primary site (breast)
59.65
15254
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each 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
59.65
15257
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each attendance at which treatment is given—one field—treatment delivered to secondary site
59.65
15260
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each 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 2.38.1
15263
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each 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 2.38.1
15266
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each 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 2.38.1
15269
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each 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 2.38.1
15272
Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities—each 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 2.38.1
Subgroup 4—Brachytherapy
15303
Intrauterine treatment alone using radioactive sealed sources having a half‑life greater than 115 days using manual afterloading techniques (Anaes.)
357.00
15304
Intrauterine treatment alone using radioactive sealed sources having a half‑life greater than 115 days using automatic afterloading techniques (Anaes.)
357.00
15307
Intrauterine treatment alone using radioactive sealed sources having a half‑life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)
676.80
15308
Intrauterine treatment alone using radioactive sealed sources having a half‑life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)
676.80
15311
Intravaginal treatment alone using radioactive sealed sources having a half‑life greater than 115 days using manual afterloading techniques (Anaes.)
333.20
15312
Intravaginal treatment alone using radioactive sealed sources having a half‑life greater than 115 days using automatic afterloading techniques (Anaes.)
330.80
15315
Intravaginal treatment alone using radioactive sealed sources having a half‑life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)
654.25
15316
Intravaginal treatment alone using radioactive sealed sources having a half‑life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)
654.25
15319
Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half‑life greater than 115 days using manual afterloading techniques (Anaes.)
406.05
15320
Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half‑life greater than 115 days using automatic afterloading techniques (Anaes.)
406.05
15323
Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half‑life of less than 115 days including iodine, gold, iridium, or tantalum using manual afterloading techniques (Anaes.)
722.00
15324
Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half‑life of less than 115 days including iodine, gold, iridium, or tantalum using automatic afterloading techniques (Anaes.)
722.00
15327
Implantation of a sealed radioactive source (having a half‑life 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.)
785.45
15328
Implantation of a sealed radioactive source (having a half‑life 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.)
785.45
15331
Implantation of a sealed radioactive source (having a half‑life 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.)
745.80
15332
Implantation of a sealed radioactive source (having a half‑life 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.)
745.80
15335
Implantation of a sealed radioactive source (having a half‑life 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.)
676.80
15336
Implantation of a sealed radioactive source (having a half‑life 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.)
676.80
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
935.60
15339
Removal of a sealed radioactive source under general anaesthesia, or under epidural or spinal nerve block (Anaes.)
76.20
15342
Construction and application of a radioactive mould using a sealed source having a half‑life of greater than 115 days, to treat intracavity, intraoral or intranasal site
190.30
15345
Construction and application of a radioactive mould using a sealed source having a half‑life of less than 115 days including iodine, gold, iridium or tantalum to treat intracavity, intraoral or intranasal sites
507.80
15348
Subsequent applications of radioactive mould referred to in item 15342 or 15345—each attendance
58.40
15351
Construction with or without initial application of a radioactive mould not exceeding 5 cm in diameter to an external surface
116.60
15354
Construction and first application of a radioactive mould more than 5 cm in diameter to an external surface
141.50
15357
Attendance upon a patient to apply a radioactive mould constructed for application to an external surface of the patient other than an attendance which is the first attendance to apply the mould—each attendance
40.05
Subgroup 5—Computerised planning
15500
Radiation field setting using a simulator or isocentric x‑ray 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)
242.65
15503
Radiation field setting using a simulator or isocentric x‑ray 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)
311.55
15506
Radiation field setting using a simulator or isocentric x‑ray 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 off‑axis fields or several joined fields (other than a service associated with a service to which item 15515 applies)
465.30
15509
Radiation field setting using a diagnostic x‑ray 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)
210.30
15512
Radiation field setting using a diagnostic x‑ray 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)
271.10
15513
Radiation source localisation using a simulator or x‑ray 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
306.55
15515
Radiation field setting using a diagnostic x‑ray 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 off‑axis fields or several joined fields (other than a service associated with a service to which item 15506 applies)
392.50
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
77.00
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
339.90
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 off‑axis fields, or several joined fields
637.35
15527
Radiation Dosimetry by a non‑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
78.95
15530
Radiation Dosimetry by a non‑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
352.15
15533
Radiation Dosimetry by a non‑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 off‑axis fields, or several joined fields
667.70
15536
Brachytherapy planning, computerised Radiation Dosimetry
266.90
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
627.30
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 high‑quality 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
658.60
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 high‑quality 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
710.55
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
664.40
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
866.55
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
1 120.75
Subgroup 6—Stereotactic radiosurgery
15600
Stereotactic radiosurgery, including all radiation oncology consultations, planning, simulation, dosimetry and treatment
1 702.30
Division 2.39—Group T3: Therapeutic nuclear medicine
2.39.1 Application of Group T3
An item in Group T3 does not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
Group T3—Therapeutic nuclear medicine
Item
Description
Fee ($)
16003
Intra‑cavitary 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.)
650.50
16006
Administration of a therapeutic dose of Iodine 131 for thyroid cancer by single dose technique
499.85
16009
Administration of a therapeutic dose of Iodine 131 for thyrotoxicosis by single dose technique
341.15
16012
Intravenous administration of a therapeutic dose of Phosphorous 32
295.15
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
4 085.70
16018
Administration of 153 Sm‑lexidronam 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
2 442.45
Division 2.40—Group T4: Obstetrics
2.40.1 Definitions for item 16400
In item 16400:
midwife means a person:
(a) who is registered under a law of a State or Territory as a midwife; and
(b) who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.
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.
practice location has the same meaning as in clause 2.31.1.
2.40.2 Meaning of amount under clause 2.40.2
(1) In item 16633:
amount under clause 2.40.2, for a second or subsequent foetus, means 50% of the fee mentioned in items 16606, 16609, 16612, 16615 and 16627 for services provided in relation to the multiple pregnancy.
(2) In item 16636:
amount under clause 2.40.2, for a second or subsequent foetus, means 50% of the amount of the fee mentioned in items 16600, 16603, 16618, 16621 and 16624 for services provided in relation to the multiple pregnancy.
2.40.3 Meaning of delivery
For items 16515, 16519, 16522, 16527, 16590 and 16591, delivery includes:
(a) induction of labour by surgical or intravenous infusion methods; and
(b) forceps or vacuum extraction; and
(c) breech delivery; and
(d) management of multiple deliveries; and
(e) episiotomy; and
(f) repair of tears; and
(g) evacuation of the products of conception by manual removal.
2.40.4 Application of Group T4
An item in Group T4 does not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
2.40.5 Application of item 16400
(1) Item 16400 applies to an antenatal service provided to a patient by a midwife, nurse or Aboriginal and Torres Strait Islander health practitioner only if:
(a) the 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 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.
2.40.5A Limitation of item 16399
Item 16399 does not apply if the patient or specialist
travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
2.40.6 Limitation of items 16590 and 16591
A service described in item 16590 or 16591 applies not more than once in a pregnancy that has progressed beyond 20 weeks.
Group T4—Obstetrics
Item
Description
Fee ($)
16399
Professional attendance on a patient by a specialist practising in his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; or
(iii) is a patient of:
50% of the fee for item 16401, 16404, 16406, 16500, 16590 or 16591
(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
16400
Antenatal service provided by a midwife, nurse or an Aboriginal and Torres Strait Islander health practitioner, to a maximum of 10 services per 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
27.25
16401
Professional attendance at consulting rooms or a hospital by a specialist in the practice of his or her specialty of obstetrics after referral of the patient to him or her—each attendance, other than a second or subsequent attendance in a single course of treatment, other than a service to which item 104 applies
85.55
16404
Professional attendance at consulting rooms or a hospital by a specialist in the practice of his or her specialty of obstetrics after referral of the patient to him or her—each attendance after the first attendance in a single course of treatment
43.00
16406
Antenatal professional attendance, as part of a single course of treatment, at 32‑36 weeks of the patient’s pregnancy when the patient is referred by a participating midwife
Payable only once for a pregnancy
133.95
16500
Antenatal attendance
47.15
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
140.55
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—each attendance that is not a routine antenatal attendance, to a maximum of one visit per day
47.15
16504
Treatment of habitual miscarriage by injection of hormones—each injection up to a maximum of 12 injections, if the injection is not administered during a routine antenatal attendance
47.15
16505
Threatened abortion, threatened miscarriage or hyperemesis gravidarum, requiring admission to hospital, treatment of—each attendance that is not a routine antenatal attendance
47.15
16508
Pregnancy complicated by acute intercurrent infection, intra‑uterine growth retardation, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital—each attendance that is not a routine antenatal attendance, to a maximum of one visit per day
47.15
16509
Pre‑eclampsia, eclampsia or antepartum haemorrhage, treatment of—each attendance that is not a routine antenatal attendance
47.15
16511
Cervix, purse string ligation of (Anaes.)
219.95
16512
Cervix, removal of purse string ligature of (Anaes.)
63.50
16514
Antenatal cardiotocography in the management of high risk pregnancy (not during the course of the confinement)
36.65
16515
Management of vaginal delivery as an independent procedure, if the patient’s care has been transferred by another medical practitioner for management of the delivery and the attending medical practitioner has not provided antenatal care to the patient, including all attendances related to the delivery (Anaes.)
450.65
16518
Management of labour, incomplete, if the patient’s care has been transferred to another medical practitioner for completion of the delivery (Anaes.)
450.65
16519
Management of labour and delivery by any means (including Caesarean section) including post‑partum care for 5 days (Anaes.)
693.95
16520
Caesarean section and post‑operative 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.)
811.05
16522
Management of labour and delivery, or delivery alone, (including Caesarean section), 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) multiple pregnancy;
(b) recurrent antepartum haemorrhage from 20 weeks gestation;
(c) grade 2, 3 or 4 placenta praevia;
(d) baby with a birth weight less than or equal to 2 500 gm;
(e) pre‑existing diabetes mellitus dependent on medication, or gestational diabetes requiring at least daily blood glucose monitoring;
(f) trial of vaginal delivery in a patient with uterine scar, or trial of vaginal breech delivery;
1 629.35
(g) pre‑existing hypertension requiring antihypertensive medication, or pregnancy induced hypertension of at least 140/90mmHg associated with at least 1+ proteinuria on urinalysis;
(h) prolonged labour greater than 12 hours with partogram evidence of abnormal cervimetric progress;
(i) fetal distress defined by significant cardiotocograph or scalp pH abnormalities requiring immediate delivery;
(j) conditions that pose a significant risk of maternal death;
(Anaes.)
16525
Management of second trimester labour, with or without induction, for intrauterine fetal death, gross fetal abnormality or life threatening maternal disease, other than a service to which item 35643 applies (Anaes.)
384.35
16527
Management of vaginal delivery, if the patient’s care has been transferred by a participating midwife for management of the delivery, including all attendances related to the delivery (Anaes.)
Payable only once for a pregnancy
450.65
16528
Caesarean section and post‑operative care for 7 days, if the patient’s care has been transferred by a participating midwife for management of the birth (Anaes.)
Payable only once for a pregnancy
811.05
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.)
218.00
16567
Management of postpartum haemorrhage by special measures such as packing of uterus, as an independent procedure (Anaes.)
318.80
16570
Acute inversion of the uterus, vaginal correction of, as an independent procedure (Anaes.)
416.05
16571
Cervix, repair of extensive laceration or lacerations (Anaes.)
318.80
16573
Third degree tear, involving anal sphincter muscles and rectal mucosa, repair of, as an independent procedure (Anaes.)
259.80
16590
Planning and management of a pregnancy that has progressed beyond 20 weeks, if the fee does not include any amount for the management of the labour and delivery and, if the practitioner intends to undertake the delivery for the privately admitted patient, the service is not a service to which item 16591 applies
324.10
16591
Planning and management of a pregnancy that has progressed beyond 20 weeks, if the fee does not include any amount for the management of the labour and delivery and, if the care of the patient will be transferred to another medical practitioner, the service is not a service to which item 16590 applies
142.65
16600
Amniocentesis, diagnostic
63.50
16603
Chorionic villus sampling, by any route
121.85
16606
Fetal blood sampling, using interventional techniques from umbilical cord or foetus, including fetal neuromuscular blockade and amniocentesis (Anaes.)
243.25
16609
Fetal intravascular blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling (Anaes.)
496.00
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.)
390.25
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.)
207.85
16618
Amniocentesis, therapeutic, when indicated because of polyhydramnios with at least 500 ml being aspirated
207.85
16621
Amnioinfusion, for diagnostic or therapeutic purposes in the presence of severe oligohydramnios
207.85
16624
Fetal fluid filled cavity, drainage of
299.10
16627
Feto‑amniotic shunt, insertion of, into fetal fluid filled cavity, including neuromuscular blockade and amniocentesis
608.95
16633
Procedure on multiple pregnancies relating to items 16606, 16609, 16612, 16615 and 16627
Amount under clause 2.40.2
16636
Procedure on multiple pregnancies relating to items 16600, 16603, 16618, 16621 and 16624
Amount under clause 2.40.2
Division 2.41—Group T6: Examination by anaesthetist
2.41.1 Application of Group T6
An item in Group T6 does not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
2.41.2 Limitation of item 17609
Item 17609 does not apply if the patient or specialist
travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
Group T6—Examination by anaesthetist
Item
Description
Fee ($)
17609
Professional attendance on a patient by a specialist practising in his or her 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 kms by road from the specialist; or
(ii) is a care recipient in a residential care service; 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 cardio‑respiratory system, of not more than 15 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
43.00
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 of more than 15 minutes in duration and not more than 30 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
85.55
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 of more than 30 minutes in duration and not more than 45 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
118.50
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 of more than 45 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
150.90
17640
Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to him or her—a brief consultation involving a short history, a limited examination, and of not more than 15 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
43.00
17645
Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to him or her—a consultation involving a selective history and examination of multiple systems, the formulation of a written patient management plan, and of more than 15 minutes in duration and not more than 30 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
85.55
17650
Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to him or her—a consultation involving a detailed history and comprehensive examination of multiple systems, and the formulation of a written patient management plan, and of more than 30 minutes in duration and not more than 45 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
118.50
17655
Professional attendance by a specialist anaesthetist in the practice of anaesthesia, if the patient is referred to him or her—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 of more than 45 minutes in duration (other than a service associated with a service to which any of items 2801 to 3000 apply)
150.90
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)
85.55
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 day‑hospital 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 is of more than 15 minutes in duration;
(other than a service associated with a service to which any of items 2801 to 3000 apply)
39.55
Division 2.42—Group T7: Regional or field nerve blocks
2.42.1 Meaning of amount under clause 2.42.1
(1) In item 18219:
amount under clause 2.42.1 means the sum of:
(a) the fee for item 18216; and
(b) $19.00 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 2.42.1 means the sum of:
(a) the fee for item 18226; and
(b) $28.60 for each additional period of 15 minutes, and part of a period of 15 minutes, of continuous attendance beyond the first hour of attendance.
2.42.2 Application of Group T7
An item in Group T7 does not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
Group T7—Regional or field nerve blocks
Item
Description
Fee ($)
18213
Intravenous regional anaesthesia of limb by retrograde perfusion
88.65
18216
Intrathecal 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.)
189.90
18219
Intrathecal 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 2.42.1
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
37.65
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
50.05
18226
Intrathecal 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
284.80
18227
Intrathecal 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 2.42.1
18228
Interpleural block, initial injection or commencement of infusion of a therapeutic substance
62.50
18230
Intrathecal or epidural injection of neurolytic substance (Anaes.)
238.45
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.)
189.90
18233
Epidural injection of blood for blood patch (Anaes.)
189.90
18234
Trigeminal nerve, primary division of, injection of an anaesthetic agent (Anaes.)
124.85
18236
Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent (Anaes.)
62.50
18238
Facial nerve, injection of an anaesthetic agent, other than a service associated with a service to which item 18240 applies
37.65
18240
Retrobulbar or peribulbar injection of an anaesthetic agent
93.60
18242
Greater occipital nerve, injection of an anaesthetic agent (Anaes.)
37.65
18244
Vagus nerve, injection of an anaesthetic agent
100.80
18246
Glossopharyngeal nerve, injection of an anaesthetic agent
100.80
18248
Phrenic nerve, injection of an anaesthetic agent
88.65
18250
Spinal accessory nerve, injection of an anaesthetic agent
62.50
18252
Cervical plexus, injection of an anaesthetic agent
100.80
18254
Brachial plexus, injection of an anaesthetic agent
100.80
18256
Suprascapular nerve, injection of an anaesthetic agent
62.50
18258
Intercostal nerve (single), injection of an anaesthetic agent
62.50
18260
Intercostal nerves (multiple), injection of an anaesthetic agent
88.65
18262
Ilio‑inguinal, iliohypogastric or genitofemoral nerves, one or more of, injection of an anaesthetic agent (Anaes.)
62.50
18264
Pudendal nerve, injection of an anaesthetic agent
100.80
18266
Ulnar, radial or median nerve, main trunk of, one or more of, injection of an anaesthetic agent, not being associated with a brachial plexus block
62.50
18268
Obturator nerve, injection of an anaesthetic agent
88.65
18270
Femoral nerve, injection of an anaesthetic agent
88.65
18272
Saphenous, sural, popliteal or posterior tibial nerve, main trunk of, one or more of, injection of an anaesthetic agent
62.50
18274
Paravertebral, cervical, thoracic, lumbar, sacral or coccygeal nerves, injection of an anaesthetic agent, (single vertebral level)
88.65
18276
Paravertebral nerves, injection of an anaesthetic agent, (multiple levels)
124.85
18278
Sciatic nerve, injection of an anaesthetic agent
88.65
18280
Sphenopalatine ganglion, injection of an anaesthetic agent (Anaes.)
124.85
18282
Carotid sinus, injection of an anaesthetic agent, as an independent percutaneous procedure
100.80
18284
Stellate ganglion, injection of an anaesthetic agent (cervical sympathetic block) (Anaes.)
147.65
18286
Lumbar or thoracic nerves, injection of an anaesthetic agent (paravertebral sympathetic block) (Anaes.)
147.65
18288
Coeliac plexus or splanchnic nerves, injection of an anaesthetic agent (Anaes.)
147.65
18290
Cranial nerve other than trigeminal, destruction by a neurolytic agent, other than a service associated with the injection of botulinum toxin (Anaes.)
249.75
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.)
124.85
18294
Coeliac plexus or splanchnic nerves, destruction by a neurolytic agent (Anaes.)
176.00
18296
Lumbar sympathetic chain, destruction by a neurolytic agent (Anaes.)
150.55
18298
Cervical or thoracic sympathetic chain, destruction by a neurolytic agent (Anaes.)
176.00
Division 2.42A—Group T11: Botulinum toxin
2.42A.1 Supply of botulinum toxin
(1) A service mentioned in any of items 18350 to 18379 does not include the supply of the botulinum toxin to which the service relates.
(2) 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.
2.42A.2 Limitation of certain items
(1) A service mentioned in item 18360 or 18365 is applicable to the first 4 treatments, not exceeding 2 for each limb, on any one day.
(2) Items 18360, 18365, 18366 and 18368 apply only to a service provided by a specialist or consultant physician in the practice of his or her speciality.
Group T11—Botulinum toxin
Item
Description
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
124.85
18351
Clostridium Botulinum Type A Toxin‑Haemagglutin 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
124.85
18353
Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin‑Haemagglutin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of cervical dystonia (spasmodic torticollis), including all such injections on any one day
249.75
18354
Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin‑Haemagglutin 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.)
124.85
18360
Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), 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; and
(e) the treatment is not provided on the same occasion as a service mentioned in item 18365
124.85
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.)
124.85
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.)
246.70
18365
Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin‑Haemagglutin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of moderate to severe spasticity of the upper limb following a stroke, if:
(a) the patient is at least 18 years of age; and
(b) treatment is provided as:
(i) second line therapy when standard treatment for the condition has failed; or
(ii) an adjunct to physical therapy; and
(c) the patient does not have established severe contracture in the limb that is to be treated; 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 upper limb), including all injections per set; and
(e) for a patient who has received treatment on 2 previous separate occasions—the patient has responded to the treatment
124.85
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.)
156.40
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
267.05
18369
Clostridium Botulinum Type A Toxin‑Haemagglutin 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.)
45.05
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.)
45.05
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.)
124.85
18374
Clostridium Botulinum Type A Toxin‑Haemagglutin 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.)
124.85
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 anti‑cholinergic 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 self‑catheterise; and
(d) the treatment is not provided on the same occasion as a service mentioned in item 104, 105, 110, 116, 119, 11900 or 11919
For each patient—applicable not more than once except if 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.)
229.85
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
For each patient—applicable not more than twice except if the patient achieves and maintains at least a 50% reduction in the number of headache days per month from baseline after 2 treatment cycles (each of 12 weeks duration)
124.85
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
229.85
(c) the patient has urinary incontinence that is inadequately controlled by at least 2 alternative anti‑cholinergic 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 self‑catheterise; and
(e) treatment is not provided on the same occasion as a service mentioned in item 104, 105, 110, 116, 119, 11900 or 11919
For each patient—applicable not more than once except if 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.)
Division 2.43—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)
2.43.1 Meaning of amount under clause 2.43.1
(1) In item 25025:
amount under clause 2.43.1 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 25015 applies to the anaesthesia—the fee mentioned in the item; and
(d) if a service mentioned in any of items 22001 to 22051 is performed in association with the anaesthesia—the fee mentioned in the item.
(2) In item 25030:
amount under clause 2.43.1 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 25015 applies to the anaesthesia—the fee mentioned in the item; and
(d) if a service mentioned in any of items 22001 to 22051 is performed in association with the assistance—the fee mentioned in the item.
(3) In item 25050:
amount under clause 2.43.1 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 25015 apply to the perfusion—the fee mentioned in the item; and
(d) if a service mentioned in any of items 22001 to 22051 or 22065 to 22075 is performed in association with the perfusion—the fee mentioned in the item.
2.43.2 Meaning of amount under clause 2.43.2
An amount under clause 2.43.2 means the sum of:
(a) $99.00; 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 mentioned in an item in the range 22001 to 22051 applies to the assistance—the fee mentioned in the item.
2.43.3 Meaning of complex paediatric case
In item 25205:
complex paediatric case means a case that involves one or more of the following services:
(a) invasive monitoring, either intravascular or transoesophageal;
(b) organ transplantation;
(c) craniofacial surgery;
(d) major tumour resection;
(e) separation of conjoint twins.
2.43.4 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.
2.43.5 Application of Group T10
(1) An item in Group T10 does not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
(2) Items 20100 to 21990 (other than item 21965 or 21981), 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.)”.
(3) 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).
(4) An item in Group T10 does not apply to a service mentioned 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.
2.43.6 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.
2.43.7 Services mentioned 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.
2.43.8 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.
2.43.9 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.
Group T10—Anaesthesia performed in connection with certain services (Relative Value Guide)
Item
Description
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
99.00
20102
Initiation of the management of anaesthesia for plastic repair of cleft lip
118.80
20104
Initiation of the management of anaesthesia for electroconvulsive therapy
79.20
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
99.00
20124
Initiation of the management of anaesthesia for otoscopy
79.20
20140
Initiation of the management of anaesthesia for procedures on eye, other than a service to which another item in this Subgroup applies
99.00
20142
Initiation of the management of anaesthesia for lens surgery
118.80
20143
Initiation of the management of anaesthesia for retinal surgery
118.80
20144
Initiation of the management of anaesthesia for corneal transplant
158.40
20145
Initiation of the management of anaesthesia for vitrectomy
158.40
20146
Initiation of the management of anaesthesia for biopsy of conjunctiva
99.00
20147
Initiation of the management of anaesthesia for squint repair
118.80
20148
Initiation of the management of anaesthesia for ophthalmoscopy
79.20
20160
Initiation of the management of anaesthesia for procedures on nose or accessory sinuses, other than a service to which another item in this Subgroup applies
118.80
20162
Initiation of the management of anaesthesia for radical surgery on the nose and accessory sinuses
138.60
20164
Initiation of the management of anaesthesia for biopsy of soft tissue of the nose and accessory sinuses
79.20
20170
Initiation of the management of anaesthesia for intraoral procedures, including biopsy, other than a service to which another item in this Subgroup applies
118.80
20172
Initiation of the management of anaesthesia for repair of cleft palate
138.60
20174
Initiation of the management of anaesthesia for excision of retropharyngeal tumour
178.20
20176
Initiation of the management of anaesthesia for radical intraoral surgery
198.00
20190
Initiation of the management of anaesthesia for procedures on facial bones, other than a service to which another item in this Subgroup applies
99.00
20192
Initiation of the management of anaesthesia for extensive surgery on facial bones (including prognathism and extensive facial bone reconstruction)
198.00
20210
Initiation of the management of anaesthesia for intracranial procedures, other than a service to which another item in this Subgroup applies
297.00
20212
Initiation of the management of anaesthesia for subdural taps
99.00
20214
Initiation of the management of anaesthesia for burr holes of the cranium
178.20
20216
Initiation of the management of anaesthesia for intracranial vascular procedures, including those for aneurysms or arterio‑venous abnormalities
396.00
20220
Initiation of the management of anaesthesia for spinal fluid shunt procedures
198.00
20222
Initiation of the management of anaesthesia for ablation of an intracranial nerve
118.80
20225
Initiation of the management of anaesthesia for all cranial bone procedures
237.60
20230
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the head or face
237.60
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
99.00
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
297.00
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
118.80
20321
Initiation of the management of anaesthesia for laryngectomy, hemi laryngectomy, laryngopharyngectomy or pharyngectomy
198.00
20330
Initiation of the management of anaesthesia for laser surgery to the airway (excluding nose and mouth)
158.40
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
198.00
20352
Initiation of the management of anaesthesia for simple ligation of major vessels of neck
99.00
20355
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the neck
237.60
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
59.40
20401
Initiation of the management of anaesthesia for procedures on the breast, other than a service to which another item in this Subgroup applies
79.20
20402
Initiation of the management of anaesthesia for reconstructive procedures on breast
99.00
20403
Initiation of the management of anaesthesia for removal of breast lump or for breast segmentectomy, if axillary node dissection is performed
99.00
20404
Initiation of the management of anaesthesia for mastectomy
118.80
20405
Initiation of the management of anaesthesia for reconstructive procedures on the breast using myocutaneous flaps
158.40
20406
Initiation of the management of anaesthesia for radical or modified radical procedures on breast with internal mammary node dissection
257.40
20410
Initiation of the management of anaesthesia for electrical conversion of arrhythmias
99.00
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
99.00
20440
Initiation of the management of anaesthesia for percutaneous bone marrow biopsy of the sternum
79.20
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
99.00
20452
Initiation of the management of anaesthesia for radical surgery on clavicle, scapula or sternum
118.80
20470
Initiation of the management of anaesthesia for partial rib resection, other than a service to which another item in this Subgroup applies
118.80
20472
Initiation of the management of anaesthesia for thoracoplasty
198.00
20474
Initiation of the management of anaesthesia for radical procedures on chest wall
257.40
20475
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior thorax
198.00
Subgroup 4—Intrathoracic
20500
Initiation of the management of anaesthesia for open procedures on the oesophagus
297.00
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
118.80
20522
Initiation of the management of anaesthesia for needle biopsy of pleura
79.20
20524
Initiation of the management of anaesthesia for pneumocentesis
79.20
20526
Initiation of the management of anaesthesia for thoracoscopy
198.00
20528
Initiation of the management of anaesthesia for mediastinoscopy
158.40
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
257.40
20542
Initiation of the management of anaesthesia for pulmonary decortication
297.00
20546
Initiation of the management of anaesthesia for pulmonary resection with thoracoplasty
297.00
20548
Initiation of the management of anaesthesia for intrathoracic repair of trauma to trachea and bronchi
297.00
20560
Initiation of the management of anaesthesia for open procedures on the heart, pericardium or great vessels of chest
396.00
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
198.00
20604
Initiation of the management of anaesthesia for posterior cervical laminectomy with the patient in the sitting position
257.40
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
198.00
20622
Initiation of the management of anaesthesia for thoracolumbar sympathectomy
257.40
20630
Initiation of the management of anaesthesia for procedures in lumbar region, other than a service to which another item in this Subgroup applies
158.40
20632
Initiation of the management of anaesthesia for lumbar sympathectomy
138.60
20634
Initiation of the management of anaesthesia for chemonucleolysis
198.00
20670
Initiation of the management of anaesthesia for extensive spine or spinal cord procedures, or both
257.40
20680
Initiation of the management of anaesthesia for manipulation of spine when performed in the operating theatre of a hospital
59.40
20690
Initiation of the management of anaesthesia for percutaneous spinal procedures, other than a service to which another item in this Subgroup applies
99.00
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
59.40
20702
Initiation of the management of anaesthesia for percutaneous liver biopsy
79.20
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
79.20
20704
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior upper abdomen
198.00
20705
Initiation of the management of anaesthesia for diagnostic laparoscopy procedures
118.80
20706
Initiation of the management of anaesthesia for laparoscopic procedures in the upper abdomen, other than a service to which another item in this Subgroup applies
138.60
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
99.00
20740
Initiation of the management of anaesthesia for upper gastrointestinal endoscopic procedures
99.00
20745
Initiation of the management of anaesthesia for upper gastrointestinal endoscopic procedures in association with acute gastrointestinal haemorrhage
118.80
20750
Initiation of the management of anaesthesia for hernia repairs in upper abdomen, other than a service to which another item in this Subgroup applies
79.20
20752
Initiation of the management of anaesthesia for repair of incisional hernia or wound dehiscence, or both
118.80
20754
Initiation of the management of anaesthesia for procedures on an omphalocele
138.60
20756
Initiation of the management of anaesthesia for transabdominal repair of diaphragmatic hernia
178.20
20770
Initiation of the management of anaesthesia for procedures on major upper abdominal blood vessels
297.00
20790
Initiation of the management of anaesthesia for procedures within the peritoneal cavity in upper abdomen including cholecystectomy, gastrectomy, laparoscopic nephrectomy or bowel shunts
158.40
20791
Initiation of the management of anaesthesia for bariatric surgery in a patient with clinically severe obesity
198.00
20792
Initiation of the management of anaesthesia for partial hepatectomy (excluding liver biopsy)
257.40
20793
Initiation of the management of anaesthesia for extended or trisegmental hepatectomy
297.00
20794
Initiation of the management of anaesthesia for pancreatectomy, partial or total
237.60
20798
Initiation of the management of anaesthesia for neuro endocrine tumour removal in the upper abdomen
198.00
20799
Initiation of the management of anaesthesia for percutaneous procedures on an intra‑abdominal organ in the upper abdomen
118.80
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
59.40
20802
Initiation of the management of anaesthesia for lipectomy of the lower abdomen
99.00
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
79.20
20804
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior lower abdomen
198.00
20805
Initiation of the management of anaesthesia for diagnostic laparoscopic procedures
118.80
20806
Initiation of the management of anaesthesia for laparoscopic procedures in the lower abdomen
138.60
20810
Initiation of the management of anaesthesia for lower intestinal endoscopic procedures
79.20
20815
Initiation of the management of anaesthesia for extracorporeal shock wave lithotripsy to urinary tract
118.80
20820
Initiation of the management of anaesthesia for procedures on the skin, its derivatives or subcutaneous tissue of the lower posterior abdominal wall
99.00
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
79.20
20832
Initiation of the management of anaesthesia for repair of incisional herniae or wound dehiscence, or both, of the lower abdomen
118.80
20840
Initiation of the management of anaesthesia for all procedures within the peritoneal cavity in lower abdomen, including appendicectomy, other than a service to which another item in this Subgroup applies
118.80
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
158.40
20842
Initiation of the management of anaesthesia for amniocentesis
79.20
20844
Initiation of the management of anaesthesia for abdominoperineal resection, including pull through procedures, ultra low anterior resection and formation of bowel reservoir
198.00
20845
Initiation of the management of anaesthesia for radical prostatectomy
198.00
20846
Initiation of the management of anaesthesia for radical hysterectomy
198.00
20847
Initiation of the management of anaesthesia for ovarian malignancy
198.00
20848
Initiation of the management of anaesthesia for pelvic exenteration
198.00
20850
Initiation of the management of anaesthesia for caesarean section
237.60
20855
Initiation of the management of anaesthesia for caesarean hysterectomy or hysterectomy within 24 hours of delivery
297.00
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
118.80
20862
Initiation of the management of anaesthesia for renal procedures, including upper one‑third of ureter
138.60
20863
Initiation of the management of anaesthesia for nephrectomy
198.00
20864
Initiation of the management of anaesthesia for total cystectomy
198.00
20866
Initiation of the management of anaesthesia for adrenalectomy
198.00
20867
Initiation of the management of anaesthesia for neuro endocrine tumour removal in the lower abdomen
198.00
20868
Initiation of the management of anaesthesia for renal transplantation (donor or recipient)
198.00
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
297.00
20882
Initiation of the management of anaesthesia for inferior vena cava ligation
198.00
20884
Initiation of the management of anaesthesia for percutaneous umbrella insertion
99.00
20886
Initiation of the management of anaesthesia for percutaneous procedures on an intra‑abdominal organ in the lower abdomen
118.80
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
59.40
20902
Initiation of the management of anaesthesia for anorectal procedures (including endoscopy or biopsy, or both)
79.20
20904
Initiation of the management of anaesthesia for radical perineal procedures, including radical perineal prostatectomy or radical vulvectomy
138.60
20905
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the perineum
198.00
20906
Initiation of the management of anaesthesia for vulvectomy
79.20
20910
Initiation of the management of anaesthesia for transurethral procedures (including urethrocyctoscopy), other than a service to which another item in this Subgroup applies
79.20
20911
Initiation of the management of anaesthesia for endoscopic ureteroscopic surgery including laser procedures
99.00
20912
Initiation of the management of anaesthesia for transurethral resection of bladder tumour or tumours
99.00
20914
Initiation of the management of anaesthesia for transurethral resection of prostate
138.60
20916
Initiation of the management of anaesthesia for bleeding post‑transurethral resection
138.60
20920
Initiation of the management of anaesthesia for procedures on external genitalia, other than a service to which another item in this Subgroup applies
79.20
20924
Initiation of the management of anaesthesia for procedures on undescended testis, unilateral or bilateral
79.20
20926
Initiation of the management of anaesthesia for radical orchidectomy, inguinal approach
79.20
20928
Initiation of the management of anaesthesia for radical orchidectomy, abdominal approach
118.80
20930
Initiation of the management of anaesthesia for orchiopexy, unilateral or bilateral
79.20
20932
Initiation of the management of anaesthesia for complete amputation of penis
79.20
20934
Initiation of the management of anaesthesia for complete amputation of penis with bilateral inguinal lymphadenectomy
118.80
20936
Initiation of the management of anaesthesia for complete amputation of penis with bilateral inguinal and iliac lymphadenectomy
158.40
20938
Initiation of the management of anaesthesia for insertion of penile prosthesis
79.20
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
79.20
20942
Initiation of the management of anaesthesia for vaginal procedures (including repair operations and urinary incontinence procedures)
99.00
20943
Initiation of the management of anaesthesia for transvaginal assisted reproductive services
79.20
20944
Initiation of the management of anaesthesia for vaginal hysterectomy
118.80
20946
Initiation of the management of anaesthesia for vaginal delivery
158.40
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
79.20
20950
Initiation of the management of anaesthesia for culdoscopy
99.00
20952
Initiation of the management of anaesthesia for hysteroscopy
79.20
20953
Initiation of the management of anaesthesia for endometrial ablation or resection in association with hysteroscopy
99.00
20954
Initiation of the management of anaesthesia for correction of inverted uterus
198.00
20956
Initiation of the management of anaesthesia for evacuation of retained products of conception, as a complication of confinement
79.20
20958
Initiation of the management of anaesthesia for manual removal of retained placenta or for repair of vaginal or perineal tear following delivery
99.00
20960
Initiation of the management of anaesthesia for vaginal procedures in the management of post partum haemorrhage, if the blood loss is greater than 500 mls
138.60
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
59.40
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
99.00
21112
Initiation of the management of anaesthesia for percutaneous bone marrow biopsy of the anterior iliac crest
79.20
21114
Initiation of the management of anaesthesia for percutaneous bone marrow biopsy of the posterior iliac crest
99.00
21116
Initiation of the management of anaesthesia for percutaneous bone marrow harvesting from the pelvis
118.80
21120
Initiation of the management of anaesthesia for procedures on the bony pelvis
118.80
21130
Initiation of the management of anaesthesia for body cast application or revision, when performed in the operating theatre of a hospital
59.40
21140
Initiation of the management of anaesthesia for interpelviabdominal (hindquarter) amputation
297.00
21150
Initiation of the management of anaesthesia for radical procedures for tumour of the pelvis, except hindquarter amputation
198.00
21155
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior pelvis
198.00
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
79.20
21170
Initiation of the management of anaesthesia for open procedures involving symphysis pubis or sacroiliac joint
158.40
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
59.40
21199
Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of the upper leg
79.20
21200
Initiation of the management of anaesthesia for closed procedures involving hip joint, when performed in the operating theatre of a hospital
79.20
21202
Initiation of the management of anaesthesia for arthroscopic procedures of the hip joint
79.20
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
118.80
21212
Initiation of the management of anaesthesia for hip disarticulation
198.00
21214
Initiation of the management of anaesthesia for total hip replacement or revision
198.00
21216
Initiation of the management of anaesthesia for bilateral total hip replacement
277.20
21220
Initiation of the management of anaesthesia for closed procedures involving upper two‑thirds of femur, when performed in the operating theatre of a hospital
79.20
21230
Initiation of the management of anaesthesia for open procedures involving upper two‑thirds of femur, other than a service to which another item in this Subgroup applies
118.80
21232
Initiation of the management of anaesthesia for above knee amputation
99.00
21234
Initiation of the management of anaesthesia for radical resection of the upper two‑thirds of femur
158.40
21260
Initiation of the management of anaesthesia for procedures involving veins of upper leg, including exploration
79.20
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
158.40
21272
Initiation of the management of anaesthesia for femoral artery ligation
79.20
21274
Initiation of the management of anaesthesia for femoral artery embolectomy
118.80
21275
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the upper leg
198.00
21280
Initiation of the management of anaesthesia for microsurgical reimplantation of upper leg
297.00
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
59.40
21321
Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of knee or popliteal area, or both
79.20
21340
Initiation of the management of anaesthesia for closed procedures on lower one‑third of femur, when performed in the operating theatre of a hospital
79.20
21360
Initiation of the management of anaesthesia for open procedures on lower one‑third of femur
99.00
21380
Initiation of the management of anaesthesia for closed procedures on knee joint when performed in the operating theatre of a hospital
59.40
21382
Initiation of the management of anaesthesia for arthroscopic procedures of knee joint
79.20
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
59.40
21392
Initiation of the management of anaesthesia for open procedures on upper ends of tibia, fibula or patella, or any of them
79.20
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
79.20
21402
Initiation of the management of anaesthesia for knee replacement
138.60
21403
Initiation of the management of anaesthesia for bilateral knee replacement
198.00
21404
Initiation of the management of anaesthesia for disarticulation of knee
99.00
21420
Initiation of the management of anaesthesia for cast application, removal or repair, involving knee joint, undertaken in a hospital
59.40
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
79.20
21432
Initiation of the management of anaesthesia for repair of arteriovenous fistula of knee or popliteal area
99.00
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
158.40
21445
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the knee or popliteal area
198.00
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
59.40
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
79.20
21462
Initiation of the management of anaesthesia for all closed procedures on lower leg, ankle or foot
59.40
21464
Initiation of the management of anaesthesia for arthroscopic procedure of ankle joint
79.20
21472
Initiation of the management of anaesthesia for repair of Achilles tendon
99.00
21474
Initiation of the management of anaesthesia for gastrocnemius recession
99.00
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
79.20
21482
Initiation of the management of anaesthesia for radical resection of bone involving lower leg, ankle or foot
99.00
21484
Initiation of the management of anaesthesia for osteotomy or osteoplasty of tibia or fibula
99.00
21486
Initiation of the management of anaesthesia for total ankle replacement
138.60
21490
Initiation of the management of anaesthesia for lower leg cast application, removal or repair, undertaken in a hospital
59.40
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
158.40
21502
Initiation of the management of anaesthesia for embolectomy of the lower leg
118.80
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
79.20
21522
Initiation of the management of anaesthesia for venous thrombectomy of the lower leg
99.00
21530
Initiation of the management of anaesthesia for microsurgical reimplantation of lower leg, ankle or foot
297.00
21532
Initiation of the management of anaesthesia for microsurgical reimplantation of toe
158.40
21535
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the lower leg
198.00
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
59.40
21610
Initiation of the management of anaesthesia for procedures on nerves, muscles, tendons, fascia or bursae of shoulder or axilla, including axillary dissection
99.00
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
79.20
21622
Initiation of the management of anaesthesia for arthroscopic procedures of shoulder joint
99.00
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
99.00
21632
Initiation of the management of anaesthesia for radical resection involving humeral head and neck, sternoclavicular joint, acromioclavicular joint or shoulder joint
118.80
21634
Initiation of the management of anaesthesia for shoulder disarticulation
178.20
21636
Initiation of the management of anaesthesia for interthoracoscapular (forequarter) amputation
297.00
21638
Initiation of the management of anaesthesia for total shoulder replacement
198.00
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
158.40
21652
Initiation of the management of anaesthesia for procedures for axillary‑brachial aneurysm
198.00
21654
Initiation of the management of anaesthesia for bypass graft of arteries of shoulder or axilla
158.40
21656
Initiation of the management of anaesthesia for axillary‑femoral bypass graft
198.00
21670
Initiation of the management of anaesthesia for procedures on veins of shoulder or axilla
79.20
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
59.40
21682
Initiation of the management of anaesthesia for shoulder spica application, when undertaken in a hospital
79.20
21685
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the shoulder or axilla
198.00
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
59.40
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
79.20
21712
Initiation of the management of anaesthesia for open tenotomy of the upper arm or elbow
99.00
21714
Initiation of the management of anaesthesia for tenoplasty of the upper arm or elbow
99.00
21716
Initiation of the management of anaesthesia for tenodesis for rupture of long tendon of biceps
99.00
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
59.40
21732
Initiation of the management of anaesthesia for arthroscopic procedures of elbow joint
79.20
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
99.00
21756
Initiation of the management of anaesthesia for radical procedures on the upper arm or elbow
118.80
21760
Initiation of the management of anaesthesia for total elbow replacement
138.60
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
158.40
21772
Initiation of the management of anaesthesia for embolectomy of arteries of the upper arm
118.80
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
79.20
21785
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the upper arm or elbow
198.00
21790
Initiation of the management of anaesthesia for microsurgical reimplantation of upper arm
297.00
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
59.40
21810
Initiation of the management of anaesthesia for procedures on the nerves, muscles, tendons, fascia, or bursae of the forearm, wrist or hand
79.20
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
59.40
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
79.20
21832
Initiation of the management of anaesthesia for total wrist replacement
138.60
21834
Initiation of the management of anaesthesia for arthroscopic procedures of the wrist joint
79.20
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
158.40
21842
Initiation of the management of anaesthesia for embolectomy of artery of forearm, wrist or hand
118.80
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
79.20
21860
Initiation of the management of anaesthesia for forearm, wrist, or hand cast application, removal or repair, when undertaken in a hospital
59.40
21865
Initiation of the management of anaesthesia for microvascular free tissue flap surgery involving the forearm, wrist or hand
198.00
21870
Initiation of the management of anaesthesia for microsurgical reimplantation of forearm, wrist or hand
297.00
21872
Initiation of the management of anaesthesia for microsurgical reimplantation of a finger
158.40
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
59.40
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
99.00
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
138.60
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
178.20
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
217.80
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
257.40
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
297.00
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
336.60
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
376.20
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
415.80
Subgroup 17—Anaesthesia for radiological or other diagnostic or therapeutic
procedures
21900
Initiation of the management of anaesthesia for injection procedure for hysterosalpingography
59.40
21906
Initiation of the management of anaesthesia for injection procedure for myelography—lumbar or thoracic
99.00
21908
Initiation of the management of anaesthesia for injection procedure for myelography—cervical
118.80
21910
Initiation of the management of anaesthesia for injection procedure for myelography—posterior fossa
178.20
21912
Initiation of the management of anaesthesia for injection procedure for discography—lumbar or thoracic
99.00
21914
Initiation of the management of anaesthesia for injection procedure for discography—cervical
118.80
21915
Initiation of the management of anaesthesia for peripheral arteriogram
99.00
21916
Initiation of the management of anaesthesia for arteriograms—cerebral, carotid or vertebral
99.00
21918
Initiation of the management of anaesthesia for retrograde arteriogram—brachial or femoral
99.00
21922
Initiation of the management of anaesthesia for computerised axial tomography scanning, magnetic resonance scanning or digital subtraction angiography scanning
138.60
21925
Initiation of the management of anaesthesia for retrograde cystography, retrograde urethrography or retrograde cystourethrography
79.20
21926
Initiation of the management of anaesthesia for fluoroscopy
99.00
21927
Initiation of the management of anaesthesia for barium enema or other opaque study of the small bowel
99.00
21930
Initiation of the management of anaesthesia for bronchography
118.80
21935
Initiation of the management of anaesthesia for phlebography
99.00
21936
Initiation of the management of anaesthesia for heart—2 dimensional real time transoesophageal examination
118.80
21939
Initiation of the management of anaesthesia for peripheral venous cannulation
59.40
21941
Initiation of the management of anaesthesia for cardiac catheterisation (including coronary arteriography, ventriculography, cardiac mapping or insertion of automatic defibrillator or transvenous pacemaker)
138.60
21942
Initiation of the management of anaesthesia for cardiac electrophysiological procedures including radio frequency ablation
198.00
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
99.00
21945
Initiation of the management of anaesthesia for lumbar puncture, cisternal puncture or epidural injection
99.00
21949
Initiation of the management of anaesthesia for harvesting of bone marrow for the purpose of transplantation
99.00
21952
Initiation of the management of anaesthesia for muscle biopsy for malignant hyperpyrexia
198.00
21955
Initiation of the management of anaesthesia for electroencephalography
99.00
21959
Initiation of the management of anaesthesia for brain stem evoked response audiometry
99.00
21962
Initiation of the management of anaesthesia for electrocochleography by extratympanic method or transtympanic membrane insertion method
99.00
21965
Initiation of the management of anaesthesia as a therapeutic procedure if it can be shown that there is a clinical need for anaesthesia, not for headache of any etiology
99.00
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)
158.40
21970
Initiation of the management of anaesthesia during hyperbaric therapy, if the medical practitioner is confined in the chamber (including the administration of oxygen)
297.00
21973
Initiation of the management of anaesthesia for brachytherapy using radioactive sealed sources
99.00
21976
Initiation of the management of anaesthesia for therapeutic nuclear medicine
99.00
21980
Initiation of the management of anaesthesia for radiotherapy
99.00
21981
Anaesthetic agent allergy testing, using skin sensitivity methods on a patient with a history of anaphylactic or anaphylactoid reaction or cardiovascular collapse
79.20
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
59.40
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.)”
79.20
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 it can be demonstrated that there is a clinical need for anaesthesia
79.20
Subgroup 19—Therapeutic and diagnostic services performed in connection
with the management of anaesthesia
22001
Collection of blood for autologous transfusion or when homologous blood is required for immediate transfusion in an emergency situation, when performed in association with the management of anaesthesia
59.40
22002
Administration of blood or bone marrow already collected, when performed in association with the management of anaesthesia
79.20
22007
Endotracheal intubation with flexible fibreoptic scope associated with difficult airway, when performed in association with the management of anaesthesia
79.20
22008
Double lumen endobronchial tube or bronchial blocker, insertion of, when performed in association with the management of anaesthesia
79.20
22012
Central venous, pulmonary arterial, systemic arterial or cardiac intracavity blood pressure monitoring by indwelling catheter—once only for each type of pressure for a patient on a calendar day:
(a) when performed in association with the management of anaesthesia for the patient; and
(b) other than a service to which item 13876 applies
59.40
22014
Central venous, pulmonary arterial, systemic arterial or cardiac intracavity blood pressure monitoring by indwelling catheter—once only for each type of pressure for a patient on a calendar day:
(a) when performed in association with the management of anaesthesia for the patient; and
(b) relating to another discrete operation on the same day for the patient; and
(c) other than a service to which item 13876 applies
59.40
22015
Right heart balloon catheter, insertion of, including pulmonary wedge pressure and cardiac output measurement, when performed in association with the management of anaesthesia
118.80
22018
Measurement of the mechanical or gas exchange function of the respiratory system, using measurements of parameters that incorporate serial arterial blood gas analysis and include at least 2 of the following parameters:
(a) pressure;
(b) volume;
(c) flow;
(d) gas concentration in inspired or expired air;
(e) alveolar gas or blood;
performed in association with the management of anaesthesia, and for which a written record of the results is prepared, other than a service associated with a service to which item 11503 applies
138.60
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
79.20
22025
Intraarterial cannulation when performed in association with the management of anaesthesia
79.20
22031
Intrathecal or epidural injection (initial) of a therapeutic substance, with or without insertion of a catheter, in association with anaesthesia and surgery, for post operative pain management, other than a service associated with a service to which item 22036 applies
99.00
22036
Intrathecal or epidural injection (subsequent) of a therapeutic substance, using an in‑situ catheter, in association with anaesthesia and surgery, for post operative pain, other than a service associated with a service to which item 22031 applies
59.40
22040
Introduction of a regional or field nerve block peri‑operatively performed in the induction room, theatre or recovery room, for the control of post operative pain, via the femoral or sciatic nerves, in conjunction with hip, knee, ankle or foot surgery
39.60
22045
Introduction of a regional or field nerve block peri‑operatively performed in the induction room, theatre or recovery room, for the control of post operative pain, via the femoral and sciatic nerves, in conjunction with hip, knee, ankle or foot surgery
59.40
22050
Introduction of a regional of field nerve block peri‑operatively performed in the induction room, theatre or recovery room, for the control of post operative pain, via the brachial plexus in conjunction with shoulder surgery
39.60
22051
Intra‑operative 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
178.20
22055
Perfusion of limb or organ using heart‑lung machine or equivalent, other than a service associated with anaesthesia to which an item in Subgroup 21 applies
237.60
22060
Whole body perfusion, cardiac bypass, using heart‑lung machine or equivalent, other than a service associated with anaesthesia to which an item in Subgroup 21 applies
396.00
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
99.00
22070
Cardioplegia, blood or crystalloid, administration by any route, that is:
(a) a service to which item 22060 applies; and
(b) not a service associated with a service to which an item in Subgroup 21 applies
198.00
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
297.00
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
118.80
22905
Initiation of the management of anaesthesia for restorative dental work
118.80
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
19.80
23021
Anaesthesia, perfusion or assistance, if the service time is more than 15 minutes but not more than 20 minutes
39.60
23022
Anaesthesia, perfusion or assistance, if the service time is more than 20 minutes but not more than 25 minutes
39.60
23023
Anaesthesia, perfusion or assistance, if the service time is more than 25 minutes but not more than 30 minutes
39.60
23031
Anaesthesia, perfusion or assistance, if the service time is more than 30 minutes but not more than 35 minutes
59.40
23032
Anaesthesia, perfusion or assistance, if the service time is more than 35 minutes but not more than 40 minutes
59.40
23033
Anaesthesia, perfusion or assistance, if the service time is more than 40 minutes but not more than 45 minutes
59.40
23041
Anaesthesia, perfusion or assistance, if the service time is more than 45 minutes but not more than 50 minutes
79.20
23042
Anaesthesia, perfusion or assistance, if the service time is more than 50 minutes but not more than 55 minutes
79.20
23043
Anaesthesia, perfusion or assistance, if the service time is more than 55 minutes but not more than 1 hour
79.20
23051
Anaesthesia, perfusion or assistance, if the service time is more than 1:01 hours but not more than 1:05 hours
99.00
23052
Anaesthesia, perfusion or assistance, if the service time is more than 1:05 hours but not more than 1:10 hours
99.00
23053
Anaesthesia, perfusion or assistance, if the service time is more than 1:10 hours but not more than 1:15 hours
99.00
23061
Anaesthesia, perfusion or assistance, if the service time is more than 1:15 hours but not more than 1:20 hours
118.80
23062
Anaesthesia, perfusion or assistance, if the service time is more than 1:20 hours but not more than 1:25 hours
118.80
23063
Anaesthesia, perfusion or assistance, if the service time is more than 1:25 hours but not more than 1:30 hours
118.80
23071
Anaesthesia, perfusion or assistance, if the service time is more than 1:30 hours but not more than 1:35 hours
138.60
23072
Anaesthesia, perfusion or assistance, if the service time is more than 1:35 hours but not more than 1:40 hours
138.60
23073
Anaesthesia, perfusion or assistance, if the service time is more than 1:40 hours but not more than 1:45 hours
138.60
23081
Anaesthesia, perfusion or assistance, if the service time is more than 1:45 hours but not more than 1:50 hours
158.40
23082
Anaesthesia, perfusion or assistance, if the service time is more than 1:50 hours but not more than 1:55 hours
158.40
23083
Anaesthesia, perfusion or assistance, if the service time is more than 1:55 hours but not more than 2:00 hours
158.40
23091
Anaesthesia, perfusion or assistance, if the service time is more than 2:00 hours but not more than 2:10 hours
178.20
23101
Anaesthesia, perfusion or assistance, if the service time is more than 2:10 hours but not more than 2:20 hours
198.00
23111
Anaesthesia, perfusion or assistance, if the service time is more than 2:20 hours but not more than 2:30 hours
217.80
23112
Anaesthesia, perfusion or assistance, if the service time is more than 2:30 hours but not more than 2:40 hours
237.60
23113
Anaesthesia, perfusion or assistance, if the service time is more than 2:40 hours but not more than 2:50 hours
257.40
23114
Anaesthesia, perfusion or assistance, if the service time is more than 2:50 hours but not more than 3:00 hours
277.20
23115
Anaesthesia, perfusion or assistance, if the service time is more than 3:00 hours but not more than 3:10 hours
297.00
23116
Anaesthesia, perfusion or assistance, if the service time is more than 3:10 hours but not more than 3:20 hours
316.80
23117
Anaesthesia, perfusion or assistance, if the service time is more than 3:20 hours but not more than 3:30 hours
336.60
23118
Anaesthesia, perfusion or assistance, if the service time is more than 3:30 hours but not more than 3:40 hours
356.40
23119
Anaesthesia, perfusion or assistance, if the service time is more than 3:40 hours but not more than 3:50 hours
376.20
23121
Anaesthesia, perfusion or assistance, if the service time is more than 3:50 hours but not more than 4:00 hours
396.00
23170
Anaesthesia, perfusion or assistance, if the service time is more than 4:00 hours but not more than 4:10 hours
415.80
23180
Anaesthesia, perfusion or assistance, if the service time is more than 4:10 hours but not more than 4:20 hours
435.60
23190
Anaesthesia, perfusion or assistance, if the service time is more than 4:20 hours but not more than 4:30 hours
455.40
23200
Anaesthesia, perfusion or assistance, if the service time is more than 4:30 hours but not more than 4:40 hours
475.20
23210
Anaesthesia, perfusion or assistance, if the service time is more than 4:40 hours but not more than 4:50 hours
495.00
23220
Anaesthesia, perfusion or assistance, if the service time is more than 4:50 hours but not more than 5:00 hours
514.80
23230
Anaesthesia, perfusion or assistance, if the service time is more than 5:00 hours but not more than 5:10 hours
534.60
23240
Anaesthesia, perfusion or assistance, if the service time is more than 5:10 hours but not more than 5:20 hours
554.40
23250
Anaesthesia, perfusion or assistance, if the service time is more than 5:20 hours but not more than 5:30 hours
574.20
23260
Anaesthesia, perfusion or assistance, if the service time is more than 5:30 hours but not more than 5:40 hours
594.00
23270
Anaesthesia, perfusion or assistance, if the service time is more than 5:40 hours but not more than 5:50 hours
613.80
23280
Anaesthesia, perfusion or assistance, if the service time is more than 5:50 hours but not more than 6:00 hours
633.60
23290
Anaesthesia, perfusion or assistance, if the service time is more than 6:00 hours but not more than 6:10 hours
653.40
23300
Anaesthesia, perfusion or assistance, if the service time is more than 6:10 hours but not more than 6:20 hours
673.20
23310
Anaesthesia, perfusion or assistance, if the service time is more than 6:20 hours but not more than 6:30 hours
693.00
23320
Anaesthesia, perfusion or assistance, if the service time is more than 6:30 hours but not more than 6:40 hours
712.80
23330
Anaesthesia, perfusion or assistance, if the service time is more than 6:40 hours but not more than 6:50 hours
732.60
23340
Anaesthesia, perfusion or assistance, if the service time is more than 6:50 hours but not more than 7:00 hours
752.40
23350
Anaesthesia, perfusion or assistance, if the service time is more than 7:00 hours but not more than 7:10 hours
772.20
23360
Anaesthesia, perfusion or assistance, if the service time is more than 7:10 hours but not more than 7:20 hours
792.00
23370
Anaesthesia, perfusion or assistance, if the service time is more than 7:20 hours but not more than 7:30 hours
811.80
23380
Anaesthesia, perfusion or assistance, if the service time is more than 7:30 hours but not more than 7:40 hours
831.60
23390
Anaesthesia, perfusion or assistance, if the service time is more than 7:40 hours but not more than 7:50 hours
851.40
23400
Anaesthesia, perfusion or assistance, if the service time is more than 7:50 hours but not more than 8:00 hours
871.20
23410
Anaesthesia, perfusion or assistance, if the service time is more than 8:00 hours but not more than 8:10 hours
891.00
23420
Anaesthesia, perfusion or assistance, if the service time is more than 8:10 hours but not more than 8:20 hours
910.80
23430
Anaesthesia, perfusion or assistance, if the service time is more than 8:20 hours but not more than 8:30 hours
930.60
23440
Anaesthesia, perfusion or assistance, if the service time is more than 8:30 hours but not more than 8:40 hours
950.40
23450
Anaesthesia, perfusion or assistance, if the service time is more than 8:40 hours but not more than 8:50 hours
970.20
23460
Anaesthesia, perfusion or assistance, if the service time is more than 8:50 hours but not more than 9:00 hours
990.00
23470
Anaesthesia, perfusion or assistance, if the service time is more than 9:00 hours but not more than 9:10 hours
1 009.80
23480
Anaesthesia, perfusion or assistance, if the service time is more than 9:10 hours but not more than 9:20 hours
1 029.60
23490
Anaesthesia, perfusion or assistance, if the service time is more than 9:20 hours but not more than 9:30 hours
1 049.40
23500
Anaesthesia, perfusion or assistance, if the service time is more than 9:30 hours but not more than 9:40 hours
1 069.20
23510
Anaesthesia, perfusion or assistance, if the service time is more than 9:40 hours but not more than 9:50 hours
1 089.00
23520
Anaesthesia, perfusion or assistance, if the service time is more than 9:50 hours but not more than 10:00 hours
1 108.80
23530
Anaesthesia, perfusion or assistance, if the service time is more than 10:00 hours but not more than 10:10 hours
1 128.60
23540
Anaesthesia, perfusion or assistance, if the service time is more than 10:10 hours but not more than 10:20 hours
1 148.40
23550
Anaesthesia, perfusion or assistance, if the service time is more than 10:20 hours but not more than 10:30 hours
1 168.20
23560
Anaesthesia, perfusion or assistance, if the service time is more than 10:30 hours but not more than 10:40 hours
1 188.00
23570
Anaesthesia, perfusion or assistance, if the service time is more than 10:40 hours but not more than 10:50 hours
1 207.80
23580
Anaesthesia, perfusion or assistance, if the service time is more than 10:50 hours but not more than 11:00 hours
1 227.60
23590
Anaesthesia, perfusion or assistance, if the service time is more than 11:00 hours but not more than 11:10 hours
1 247.40
23600
Anaesthesia, perfusion or assistance, if the service time is more than 11:10 hours but not more than 11:20 hours
1 267.20
23610
Anaesthesia, perfusion or assistance, if the service time is more than 11:20 hours but not more than 11:30 hours
1 287.00
23620
Anaesthesia, perfusion or assistance, if the service time is more than 11:30 hours but not more than 11:40 hours
1 306.80
23630
Anaesthesia, perfusion or assistance, if the service time is more than 11:40 hours but not more than 11:50 hours
1 326.60
23640
Anaesthesia, perfusion or assistance, if the service time is more than 11:50 hours but not more than 12:00 hours
1 346.40
23650
Anaesthesia, perfusion or assistance, if the service time is more than 12:00 hours but not more than 12:10 hours
1 366.20
23660
Anaesthesia, perfusion or assistance, if the service time is more than 12:10 hours but not more than 12:20 hours
1 386.00
23670
Anaesthesia, perfusion or assistance, if the service time is more than 12:20 hours but not more than 12:30 hours
1 405.80
23680
Anaesthesia, perfusion or assistance, if the service time is more than 12:30 hours but not more than 12:40 hours
1 425.60
23690
Anaesthesia, perfusion or assistance, if the service time is more than 12:40 hours but not more than 12:50 hours
1 445.40
23700
Anaesthesia, perfusion or assistance, if the service time is more than 12:50 hours but not more than 13:00 hours
1 465.20
23710
Anaesthesia, perfusion or assistance, if the service time is more than 13:00 hours but not more than 13:10 hours
1 485.00
23720
Anaesthesia, perfusion or assistance, if the service time is more than 13:10 hours but not more than 13:20 hours
1 504.80
23730
Anaesthesia, perfusion or assistance, if the service time is more than 13:20 hours but not more than 13:30 hours
1 524.60
23740
Anaesthesia, perfusion or assistance, if the service time is more than 13:30 hours but not more than 13:40 hours
1 544.40
23750
Anaesthesia, perfusion or assistance, if the service time is more than 13:40 hours but not more than 13:50 hours
1 564.20
23760
Anaesthesia, perfusion or assistance, if the service time is more than 13:50 hours but not more than 14:00 hours
1 584.00
23770
Anaesthesia, perfusion or assistance, if the service time is more than 14:00 hours but not more than 14:10 hours
1 603.80
23780
Anaesthesia, perfusion or assistance, if the service time is more than 14:10 hours but not more than 14:20 hours
1 623.60
23790
Anaesthesia, perfusion or assistance, if the service time is more than 14:20 hours but not more than 14:30 hours
1 643.40
23800
Anaesthesia, perfusion or assistance, if the service time is more than 14:30 hours but not more than 14:40 hours
1 663.20
23810
Anaesthesia, perfusion or assistance, if the service time is more than 14:40 hours but not more than 14:50 hours
1 683.00
23820
Anaesthesia, perfusion or assistance, if the service time is more than 14:50 hours but not more than 15:00 hours
1 702.80
23830
Anaesthesia, perfusion or assistance, if the service time is more than 15:00 hours but not more than 15:10 hours
1 722.60
23840
Anaesthesia, perfusion or assistance, if the service time is more than 15:10 hours but not more than 15:20 hours
1 742.40
23850
Anaesthesia, perfusion or assistance, if the service time is more than 15:20 hours but not more than 15:30 hours
1 762.20
23860
Anaesthesia, perfusion or assistance, if the service time is more than 15:30 hours but not more than 15:40 hours
1 782.00
23870
Anaesthesia, perfusion or assistance, if the service time is more than15:40 hours but not more than 15:50 hours
1 801.80
23880
Anaesthesia, perfusion or assistance, if the service time is more than 15:50 hours but not more than 16:00 hours
1 821.60
23890
Anaesthesia, perfusion or assistance, if the service time is more than 16:00 hours but not more than 16:10 hours
1 841.40
23900
Anaesthesia, perfusion or assistance, if the service time is more than 16:10 hours but not more than 16:20 hours
1 861.20
23910
Anaesthesia, perfusion or assistance, if the service time is more than 16:20 hours but not more than 16:30 hours
1 881.00
23920
Anaesthesia, perfusion or assistance, if the service time is more than 16:30 hours but not more than 16:40 hours
1 900.80
23930
Anaesthesia, perfusion or assistance, if the service time is more than 16:40 hours but not more than 16:50 hours
1 920.60
23940
Anaesthesia, perfusion or assistance, if the service time is more than 16:50 hours but not more than 17:00 hours
1 940.40
23950
Anaesthesia, perfusion or assistance, if the service time is more than 17:00 hours but not more than 17:10 hours
1 960.20
23960
Anaesthesia, perfusion or assistance, if the service time is more than 17:10 hours but not more than 17:20 hours
1 980.00
23970
Anaesthesia, perfusion or assistance, if the service time is more than 17:20 hours but not more than 17:30 hours
1 999.80
23980
Anaesthesia, perfusion or assistance, if the service time is more than 17:30 hours but not more than 17:40 hours
2 019.60
24100
Anaesthesia, perfusion or assistance, if the service time is more than 17:50 hours but not more than 18:00 hours
2 059.20
24101
Anaesthesia, perfusion or assistance, if the service time is more than 18:00 hours but not more than 18:10 hours
2 079.00
24102
Anaesthesia, perfusion or assistance, if the service time is more than 18:10 hours but not more than 18:20 hours
2 098.80
24103
Anaesthesia, perfusion or assistance, if the service time is more than 18:20 hours but not more than 18:30 hours
2 118.60
24104
Anaesthesia, perfusion or assistance, if the service time is more than 18:30 hours but not more than 18:40 hours
2 138.40
24105
Anaesthesia, perfusion or assistance, if the service time is more than 18:40 hours but not more than 18:50 hours
2 158.20
24106
Anaesthesia, perfusion or assistance, if the service time is more than 18:50 hours but not more than 19:00 hours
2 178.00
24107
Anaesthesia, perfusion or assistance, if the service time is more than 19:00 hours but not more than 19:10 hours
2 197.80
24108
Anaesthesia, perfusion or assistance, if the service time is more than 19:10 hours but not more than 19:20 hours
2 217.60
24109
Anaesthesia, perfusion or assistance, if the service time is more than 19:20 hours but not more than 19:30 hours
2 237.40
24110
Anaesthesia, perfusion or assistance, if the service time is more than 19:30 hours but not more than 19:40 hours
2 257.20
24111
Anaesthesia, perfusion or assistance, if the service time is more than 19:40 hours but not more than 19:50 hours
2 277.00
24112
Anaesthesia, perfusion or assistance, if the service time is more than 19:50 hours but not more than 20:00 hours
2 296.80
24113
Anaesthesia, perfusion or assistance, if the service time is more than 20:00 hours but not more than 20:10 hours
2 316.60
24114
Anaesthesia, perfusion or assistance, if the service time is more than 20:10 hours but not more than 20:20 hours
2 336.40
24115
Anaesthesia, perfusion or assistance, if the service time is more than 20:20 hours but not more than 20:30 hours
2 356.20
24116
Anaesthesia, perfusion or assistance, if the service time is more than 20:30 hours but not more than 20:40 hours
2 376.00
24117
Anaesthesia, perfusion or assistance, if the service time is more than 20:40 hours but not more than 20:50 hours
2 395.80
24118
Anaesthesia, perfusion or assistance, if the service time is more than 20:50 hours but not more than 21:00 hours
2 415.60
24119
Anaesthesia, perfusion or assistance, if the service time is more than 21:00 hours but not more than 21:10 hours
2 435.40
24120
Anaesthesia, perfusion or assistance, if the service time is more than 21:10 hours but not more than 21:20 hours
2 455.20
24121
Anaesthesia, perfusion or assistance, if the service time is more than 21:20 hours but not more than 21:30 hours
2 475.00
24122
Anaesthesia, perfusion or assistance, if the service time is more than 21:30 hours but not more than 21:40 hours
2 494.80
24123
Anaesthesia, perfusion or assistance, if the service time is more than 21:40 hours but not more than 21:50 hours
2 514.60
24124
Anaesthesia, perfusion or assistance, if the service time is more than 21:50 hours but not more than 22:00 hours
2 534.40
24125
Anaesthesia, perfusion or assistance, if the service time is more than 22:00 hours but not more than 22:10 hours
2 554.20
24126
Anaesthesia, perfusion or assistance, if the service time is more than 22:10 hours but not more than 22:20 hours
2 574.00
24127
Anaesthesia, perfusion or assistance, if the service time is more than 22:20 hours but not more than 22:30 hours
2 593.80
24128
Anaesthesia, perfusion or assistance, if the service time is more than 22:30 hours but not more than 22:40 hours
2 613.60
24129
Anaesthesia, perfusion or assistance, if the service time is more than 22:40 hours but not more than 22:50 hours
2 633.40
24130
Anaesthesia, perfusion or assistance, if the service time is more than 22:50 hours but not more than 23:00 hours
2 653.20
24131
Anaesthesia, perfusion or assistance, if the service time is more than 23:00 hours but not more than 23:10 hours
2 673.00
24132
Anaesthesia, perfusion or assistance, if the service time is more than 23:10 hours but not more than 23:20 hours
2 692.80
24133
Anaesthesia, perfusion or assistance, if the service time is more than 23:20 hours but not more than 23:30 hours
2 712.60
24134
Anaesthesia, perfusion or assistance, if the service time is more than 23:30 hours but not more than 23:40 hours
2 732.40
24135
Anaesthesia, perfusion or assistance, if the service time is more than 23:40 hours but not more than 23:50 hours
2 752.20
24136
Anaesthesia, perfusion or assistance, if the service time is more than 23:50 hours but not more than 24:00 hours
2 772.00
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)
19.80
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)
39.60
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)
59.40
Subgroup 23—Anaesthesia, perfusion and assistance at anaesthesia
(modifying components—other)
25015
Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient’s age is less than 12 months or is 70 years or more
19.80
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
39.60
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 2.43.1
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 2.43.1
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 2.43.1
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 2.43.2
25205
Assistance in the management of elective anaesthesia, if:
(a) the patient has complex airway problems; or
(b) the patient is a neonate or a complex paediatric case; or
(c) there is anticipated to be massive blood loss (greater than 50% of blood volume) during the procedure; or
(d) the patient is critically ill, with multiple organ failure; or
(e) 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 2.43.2
Division 2.44—Group T8: Surgical operations
Subdivision A—General
2.44.1 Meaning of approved site
In items 37220 and 37227:
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.
2.44.2 Application of Group T8
An item in Group T8 does not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
Subdivision B—Subgroup 1 of Group T8
2.44.4 Meaning of amount under clause 2.44.4
In item 30001:
amount under clause 2.44.4 means 50% of the fee that would normally apply for a surgical procedure if the surgical procedure had not been discontinued before completion.
2.44.5 Meaning of amount under clause 2.44.5
In item 31340:
amount under clause 2.44.5, 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.
2.44.6 Meaning of qualified surgeon
For items 31539 and 31545, a medical practitioner is a qualified surgeon if:
(a) he or she is a specialist in the practice of his or her specialty of surgery; and
(b) the Chief Executive Medicare has received a written notice from the Royal Australasian College of Surgeons stating that the person meets the skills requirements for providing services to which the items apply.
2.44.7 Meaning of qualified radiologist
For item 31542, a medical practitioner is a qualified radiologist if:
(a) he or she is a specialist in the practice of his or her specialty of radiology; and
(b) the Chief Executive Medicare has received a written notice from the Royal Australian and New Zealand College of Radiologists stating that the person meets the skills requirements for providing services to which the item applies.
2.44.8 Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures
For items 30196 to 30205, 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.
2.44.9 Application of items 30299 and 30300
A service described in item 30299 or 30300 applies only if pre‑operative lymphoscinitigraphy is used because the patient is allergic to lymphotrophic dye.
2.44.10 Application of items 30440, 30451, 30492 and 30495
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.
2.44.11 Application of items 30688, 30690, 30692 and 30694
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.
2.44.12 Application of item 35412
(1) Intra‑operative 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) Pre‑operative 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.
2.44.12A Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590
(1) A service mentioned in item 31569, 31572, 31575, 31578, 31581, 31584, 31587 or 31590 may only be claimed once for a patient for the same occasion.
(2) If 2 or more services mentioned in item 31569, 31572, 31575, 31578, 31581, 31584, 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.
Group T8—Surgical operations
Item
Description
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 2.44.4
30003
Localised burns, dressing of, (not involving grafting)—each attendance at which the procedure is performed, including any associated consultation
36.30
30006
Extensive burns, dressing of, without anaesthesia (not involving grafting)—each attendance at which the procedure is performed, including any associated consultation
46.50
30009
Localised burns, dressing of, under general anaesthesia (not involving grafting) (G) (H) (Anaes.)
60.75
30010
Localised burns, dressing of, under general anaesthesia (not involving grafting) (S) (H) (Anaes.)
73.90
30013
Extensive burns, dressing of, under general anaesthesia (not involving grafting) (G) (H) (Anaes.)
130.90
30014
Extensive burns, dressing of, under general anaesthesia (not involving grafting) (S) (H) (Anaes.)
155.40
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.)
326.05
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.)
635.00
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.)
326.05
30024
Wound of soft tissue, debridement of an extensively infected post‑surgical incision or Fournier’s gangrene, under general anaesthesia, or regional or field nerve block, including suturing of the wound if carried out (Anaes.) (Assist.)
326.05
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.)
52.20
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.)
90.00
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.)
82.50
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.)
117.55
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.)
90.00
30041
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), involving deeper tissue, other than a service to which another item in Group T4 applies (G) (Anaes.)
144.00
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 (S) (Anaes.)
185.60
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.)
117.55
30048
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 (G) (Anaes.)
149.75
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 (S) (Anaes.)
185.60
30052
Full thickness laceration of ear, eyelid, nose or lip, repair of, with accurate apposition of each layer of tissue (Anaes.) (Assist.)
254.00
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.)
73.90
30058
Post‑operative haemorrhage, control of, under general anaesthesia, as an independent procedure (Anaes.)
144.35
30061
Superficial foreign body, removal of, (including from cornea or sclera) as an independent procedure (Anaes.)
23.50
30062
Etonogestrel subcutaneous implant, removal of, as an independent procedure (Anaes.)
60.75
30064
Subcutaneous foreign body, removal of, requiring incision and exploration, including closure of wound if performed, as an independent procedure (Anaes.)
109.90
30067
Foreign body in muscle, tendon or other deep tissue, removal of, as an independent procedure (G) (Anaes.) (Assist.)
223.60
30068
Foreign body in muscle, tendon or other deep tissue, removal of, as an independent procedure (S) (Anaes.) (Assist.)
276.80
30071
Diagnostic biopsy of skin or mucous membrane, as an independent procedure, if the biopsy specimen is sent for pathological examination (Anaes.)
52.20
30074
Diagnostic biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure, if the biopsy specimen is sent for pathological examination (G) (Anaes.)
117.55
30075
Diagnostic biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure, if the biopsy specimen is sent for pathological examination (S) (Anaes.)
149.75
30078
Diagnostic drill biopsy of lymph gland, deep tissue or organ, as an independent procedure, if the biopsy specimen is sent for pathological examination (Anaes.)
48.45
30081
Diagnostic biopsy of bone marrow by trephine using an open approach, if the biopsy specimen is sent for pathological examination (Anaes.)
109.90
30084
Diagnostic biopsy of bone marrow by trephine using a percutaneous approach, if the biopsy specimen is sent for pathological examination (Anaes.)
58.80
30087
Diagnostic biopsy of bone marrow by aspiration or punch biopsy of synovial membrane, if the biopsy specimen is sent for pathological examination (Anaes.)
29.45
30090
Diagnostic biopsy of pleura, percutaneous, if the biopsy specimen is sent for pathological examination—one or more biopsies on any one occasion (Anaes.)
128.55
30093
Diagnostic needle biopsy of vertebra, if the biopsy specimen is sent for pathological examination (Anaes.)
171.55
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.)
189.40
30096
Diagnostic scalene node biopsy, by open procedure, if the specimen excised is sent for pathological examination (Anaes.)
183.90
30097
Personal performance of a Synacthen Stimulation Test, including associated consultation, by a medical practitioner with resuscitation training and access to facilities when life support procedures can be implemented
97.15
30099
Sinus, excision of, involving superficial tissue only (Anaes.)
90.00
30102
Sinus, excision of, involving muscle and deep tissue (G) (Anaes.)
149.75
30103
Sinus, excision of, involving muscle and deep tissue (S) (Anaes.)
183.90
30104
Pre‑auricular sinus, excision of (Anaes.)
126.90
30106
Ganglion or small bursa, excision of, other than a service associated with a service to which another item in this Group applies (G) (Anaes.)
155.40
30107
Ganglion or small bursa, excision of, other than a service associated with a service to which another item in this Group applies (S) (Anaes.)
219.95
30110
Bursa (large), including olecranon, calcaneum or patella, excision of (G) (Anaes.) (Assist.)
284.35
30111
Bursa (large), including olecranon, calcaneum or patella, excision of (S) (Anaes.) (Assist.)
371.50
30114
Bursa, semimembranosus (Baker’s cyst), excision of (H) (Anaes.) (Assist.)
371.50
30165
Lipectomy—transverse wedge excision of abdominal apron, other than a service associated with a service to which item 45530, 45564 or 45565 applies, or a service performed within 12 months after the end of a pregnancy of the patient (H) (Anaes.) (Assist.)
454.85
30168
Lipectomy—wedge excision of skin and fat, other than a service associated with a service to which item 45530, 45564 or 45565 applies, or a service to which item 30165 applies—one excision (H) (Anaes.) (Assist.)
454.85
30171
Lipectomy—wedge excision of skin and fat, other than a service associated with a service to which item 45530, 45564 or 45565 applies, or a service to which item 30165 applies—2 or more excisions (H) (Anaes.) (Assist.)
691.75
30174
Lipectomy—subumbilical excision with undermining of skin edges and strengthening of musculo‑aponeurotic wall, other than a service associated with a service to which item 45530, 45564 or 45565 applies (H) (Anaes.) (Assist.)
691.75
30177
Lipectomy—radical abdominoplasty (Pitanguy type or similar) with excision of skin and subcutaneous tissue, repair of musculo‑aponeurotic layer and transposition of umbilicus, other than a service associated with a service to which item 45530, 45564 or 45565 applies, or a service performed within 12 months after the end of a pregnancy of the patient (H) (Anaes.) (Assist.)
985.70
30180
Axillary hyperhidrosis, partial excision for (Anaes.)
136.50
30183
Axillary hyperhidrosis, total excision of sweat gland bearing area (Anaes.)
246.50
30185
Palmar or plantar warts (10 or more), definitive removal of, excluding ablative methods alone, other than a service to which item 30186 or 30187 applies
182.50
30186
Palmar or plantar warts (for each wart, up to a total of 9 warts), definitive removal of, excluding ablative methods alone, other than a service to which item 30185 or 30187 applies (Anaes.)
Note: Section 15 of the Act provides for the reduction of the fees payable for 2 or more removals performed on the same patient on the same occasion.
47.45
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 his or her specialty (5 or more warts) (Anaes.)
256.95
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.)
147.30
30190
Angiofibromas, trichoepitheliomas or other severely disfiguring tumours of the face or neck, suitable for laser excision as confirmed by specialist opinion—removal of, by serial curettage or carbon dioxide laser or erbium laser excision‑ablation, including any associated resurfacing (10 or more tumours) (Anaes.)
397.75
30192
Premalignant skin lesions (including solar keratoses), treatment of, by ablative technique (10 or more lesions) (Anaes.)
39.55
30195
Benign neoplasm of skin, other than viral verrucae (common warts), seborrheic keratoses, cysts and skin tags, treatment by electrosurgical destruction, simple curettage or shave excision, or laser photocoagulation, other than a service to which item 30196, 30197, 30202, 30203 or 30205 applies (one or more lesions) (Anaes.)
63.50
30196
Malignant neoplasm of skin or mucous membrane proven by histopathology or confirmed by specialist opinion, removal of, by serial curettage or carbon dioxide laser or erbium laser excision‑ablation, including any associated cryotherapy, or diathermy, other than a service to which item 30197 applies (Anaes.)
126.30
30197
Malignant neoplasm of skin or mucous membrane proven by histopathology or confirmed by specialist opinion, removal of, by serial curettage or carbon dioxide laser excision‑ablation, including any associated cryotherapy or diathermy (10 or more lesions) (Anaes.)
440.05
30202
Malignant neoplasm of skin or mucous membrane proven by histopathology or confirmed by specialist opinion, removal of, by liquid nitrogen cryotherapy using repeat freeze‑thaw cycles, other than a service to which item 30203 applies
48.35
30203
Malignant neoplasm of skin or mucous membrane proven by histopathology or confirmed by specialist opinion, removal of, by liquid nitrogen cryotherapy using repeat freeze‑thaw cycles (10 or more lesions)
170.25
30205
Malignant neoplasm of skin proven by histopathology, removal of, by liquid nitrogen cryotherapy using repeat freeze‑thaw cycles if the malignant neoplasm extends into cartilage (Anaes.)
126.30
30207
Skin lesions, multiple injections with hydrocortisone or similar preparations (Anaes.)
44.60
30210
Keloid and other skin lesions, extensive, multiple injections of hydrocortisone or similar preparations if undertaken in the operating theatre of a hospital (Anaes.)
162.95
30213
Telangiectases or starburst vessels on the head or neck if lesions are visible from 4 metres, diathermy or sclerosant injection of, including associated consultation—limited to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period—for a session of at least 20 minutes in duration (Anaes.)
109.80
30214
Telangiectases or starburst vessels on the head or neck if lesions are visible from 4 metres, diathermy or sclerosant injection of, including associated consultation‑session of at least 20 minutes in duration—if it can be demonstrated that a seventh or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period
109.80
30216
Haematoma, aspiration of (Anaes.)
27.35
30219
Haematoma, furuncle, small abscess or similar lesion not requiring admission to a hospital, incision with drainage of, excluding after‑care
27.35
30223
Large haematoma, large abscess, carbuncle, cellulitis or similar lesion, incision with drainage of, excluding after‑care (H) (Anaes.)
162.95
30224
Percutaneous drainage of deep abscess using interventional techniques—but not including imaging (Anaes.)
237.60
30225
Abscess drainage tube, exchange of using interventional techniques—but not including imaging (Anaes.)
267.65
30226
Muscle, excision of (limited) or fasciotomy (Anaes.)
149.75
30229
Muscle, excision of (extensive) (Anaes.) (Assist.)
272.95
30232
Muscle, ruptured, repair of (limited), not associated with external wound (Anaes.)
223.60
30235
Muscle, ruptured, repair of (extensive), not associated with external wound (Anaes.) (Assist.)
295.70
30238
Fascia, deep, repair of, for herniated muscle (Anaes.)
149.75
30241
Bone tumour, innocent, excision of, other than a service to which another item in this Group applies (Anaes.) (Assist.)
356.35
30244
Styloid process of temporal bone, removal of (H) (Anaes.) (Assist.)
356.35
30246
Parotid duct, repair of, using micro‑surgical techniques (H) (Anaes.) (Assist.)
689.80
30247
Parotid gland, total extirpation of (H) (Anaes.) (Assist.)
739.35
30250
Parotid gland, total extirpation of with preservation of facial nerve (H) (Anaes.) (Assist.)
1 251.10
30251
Recurrent parotid tumour, excision of, with preservation of facial nerve (Anaes.) (Assist.)
1 921.75
30253
Parotid gland, superficial lobectomy of, with exposure of facial nerve (H) (Anaes.) (Assist.)
834.05
30255
Submandibular ducts, relocation of, for surgical control of drooling (H) (Anaes.) (Assist.)
1 110.65
30256
Submandibular gland, extirpation of (H) (Anaes.) (Assist.)
445.40
30259
Sublingual gland, extirpation of (Anaes.)
198.50
30262
Salivary gland, dilatation or diathermy of duct (Anaes.)
58.80
30265
Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, one or more such procedures (G) (Anaes.)
117.55
30266
Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, one or more such procedures (S) (Anaes.)
149.75
30269
Salivary gland, repair of cutaneous fistula of (Anaes.)
149.75
30272
Tongue, partial excision of (Anaes.) (Assist.)
295.70
30275
Radical excision of intra‑oral tumour involving resection of mandible and lymph glands of neck (commando‑type operation) (H) (Anaes.) (Assist.)
1 762.75
30278
Tongue tie, repair of, other than a service to which another item in this Group applies (Anaes.)
46.50
30281
Tongue tie, mandibular frenulum or maxillary frenulum, repair of, in a person aged 2 years and over, under general anaesthesia (Anaes.)
119.50
30282
Ranula or mucous cyst of mouth, removal of (G) (Anaes.)
155.40
30283
Ranula or mucous cyst of mouth, removal of (S) (Anaes.)
204.70
30286
Branchial cyst, removal of (Anaes.) (Assist.)
397.85
30289
Branchial fistula, removal of (H) (Anaes.) (Assist.)
502.25
30293
Cervical oesophagostomy, or closure of cervical oesophagostomy with or without plastic repair (Anaes.) (Assist.)
445.40
30294
Cervical oesophagectomy with tracheostomy and oesophagostomy, with or without plastic reconstruction, or laryngopharyngectomy with tracheostomy and plastic reconstruction (H) (Anaes.) (Assist.)
1 762.75
30296
Thyroidectomy, total (H) (Anaes.) (Assist.)
1 023.70
30297
Thyroidectomy following previous thyroid surgery (H) (Anaes.) (Assist.)
1 023.70
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.)
637.45
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.)
764.90
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.)
509.95
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.)
611.85
30306
Total hemithyroidectomy (H) (Anaes.) (Assist.)
798.65
30308
Bilateral sub‑total thyroidectomy (H) (Anaes.) (Assist.)
798.65
30309
Thyroidectomy, sub‑total for thyrotoxicosis (H) (Anaes.) (Assist.)
1 023.70
30310
Thyroid, unilateral sub‑total thyroidectomy or equivalent partial thyroidectomy (H) (Anaes.) (Assist.)
457.40
30313
Thyroglossal cyst, removal of (Anaes.) (Assist.)
272.95
30314
Thyroglossal cyst or fistula or both, radical removal of, including thyroglossal duct and portion of hyoid bone (H) (Anaes.) (Assist.)
457.40
30315
Parathyroid operation for hyperparathyroidism (H) (Anaes.) (Assist.)
1 139.90
30317
Cervical re‑exploration for recurrent or persistent hyperparathyroidism (H) (Anaes.) (Assist.)
1 364.90
30318
Mediastinum, exploration of, via the cervical route, for hyperparathyroidism (including thymectomy) (H) (Anaes.) (Assist.)
907.60
30320
Mediastinum, exploration of, via mediastinotomy, for hyperparathyroidism (including thymectomy) (H) (Anaes.) (Assist.)
1 364.90
30321
Retroperitoneal neuroendocrine tumour, removal of (H) (Anaes.) (Assist.)
907.60
30323
Retroperitoneal neuroendocrine tumour, removal of, requiring complex and extensive dissection (H) (Anaes.) (Assist.)
1 364.90
30324
Adrenal gland tumour, excision of (H) (Anaes.) (Assist.)
1 364.90
30329
Lymph glands of groin, limited excision of (Anaes.)
246.95
30330
Lymph glands of groin, radical excision of (H) (Anaes.) (Assist.)
718.75
30332
Lymph nodes of axilla, limited excision of (sampling) (H) (Anaes.) (Assist.)
346.75
30335
Lymph nodes of axilla, complete excision of, to level I (H) (Anaes.) (Assist.)
866.85
30336
Lymph nodes of axilla, complete excision of, to level II or III (H) (Anaes.) (Assist.)
1 040.25
30373
Laparotomy (exploratory), including associated biopsies, if no other intra‑abdominal procedure is performed (H) (Anaes.) (Assist.)
483.25
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 (adult) or drainage of pancreas (H) (Anaes.) (Assist.)
521.25
30376
Laparotomy involving division of peritoneal adhesions (if no other intra‑abdominal procedure is performed) (H) (Anaes.) (Assist.)
521.25
30378
Laparotomy involving division of adhesions in association with another intra‑abdominal procedure if the time taken to divide the adhesions is between 45 minutes and 2 hours (H) (Anaes.) (Assist.)
523.70
30379
Laparotomy with division of extensive adhesions (duration greater than 2 hours) with or without insertion of long intestinal tube (H) (Anaes.) (Assist.)
928.15
30382
Enterocutaneous fistula, radical repair of, involving extensive dissection and resection of bowel (H) (Anaes.) (Assist.)
1 306.90
30384
Laparotomy for grading of lymphoma, including splenectomy, liver biopsies, lymph node biopsies and oophoropexy (H) (Anaes.) (Assist.)
1 099.40
30385
Laparotomy for control of post‑operative haemorrhage, if no other procedure is performed (H) (Anaes.) (Assist.)
563.30
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.)
635.00
30388
Laparotomy for trauma involving 3 or more organs (H) (Anaes.) (Assist.)
1 597.55
30390
Laparoscopy, diagnostic, other than a service associated with another laparoscopic procedure (H) (Anaes.)
219.95
30391
Laparoscopy, with biopsy (H) (Anaes.) (Assist.)
284.35
30392
Radical or debulking operation for advanced intra‑abdominal malignancy, with or without omentectomy, as an independent procedure (H) (Anaes.) (Assist.)
674.50
30393
Laparoscopic division of adhesions in association with another intra‑abdominal procedure if the time taken to divide the adhesions exceeds 45 minutes (H) (Anaes.) (Assist.)
523.70
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.)
492.85
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.)
1 016.55
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.)
232.35
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.)
319.60
30400
Laparotomy with insertion of portacath for administration of cytotoxic therapy including placement of reservoir (H) (Anaes.) (Assist.)
632.50
30402
Retroperitoneal abscess, drainage of, not involving laparotomy (H) (Anaes.) (Assist.)
464.60
30403
Ventral, incisional, or recurrent hernia or burst abdomen, repair of, with or without mesh (H) (Anaes.) (Assist.)
521.25
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.)
914.95
30406
Paracentesis abdominis (Anaes.)
52.20
30408
Peritoneo venous shunt, insertion of (H) (Anaes.) (Assist.)
392.10
30409
Liver biopsy, percutaneous (Anaes.)
174.45
30411
Liver biopsy by wedge excision when performed in association with another intra‑abdominal procedure (H) (Anaes.)
88.80
30412
Liver biopsy by core needle, when performed in conjunction with another intra‑abdominal procedure (Anaes.)
52.35
30414
Liver, subsegmental resection of, (local excision), other than for trauma (H) (Anaes.) (Assist.)
689.80
30415
Liver, segmental resection of, other than for trauma (H) (Anaes.) (Assist.)
1 379.50
30416
Liver cyst, laparoscopic marsupialisation of, if the size of the cyst is greater than 5 cm in diameter (H) (Anaes.) (Assist.)
748.95
30417
Liver cysts, laparoscopic marsupialisation of 5 or more, including any cyst greater than 5 cm in diameter (H) (Anaes.) (Assist.)
1 123.40
30418
Liver, lobectomy of, other than for trauma (H) (Anaes.) (Assist.)
1 597.55
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.)
817.10
30421
Liver, tri‑segmental resection (extended lobectomy) of, other than for trauma (H) (Anaes.) (Assist.)
1 996.55
30422
Liver, repair of superficial laceration of, for trauma (H) (Anaes.) (Assist.)
675.35
30425
Liver, repair of deep multiple lacerations of, or debridement of, for trauma (H) (Anaes.) (Assist.)
1 306.90
30427
Liver, segmental resection of, for trauma (H) (Anaes.) (Assist.)
1 560.95
30428
Liver, lobectomy of, for trauma (Anaes.) (Assist.)
1 670.00
30430
Liver, extended lobectomy (tri‑segmental resection) of, for trauma (Anaes.) (Assist.)
2 323.30
30431
Liver abscess, open abdominal drainage of (Anaes.) (Assist.)
521.25
30433
Liver abscess (multiple), open abdominal drainage of (H) (Anaes.) (Assist.)
726.05
30434
Hydatid cyst of liver, peritoneum or viscus, complete removal of contents of, with or without suture of biliary radicles (H) (Anaes.) (Assist.)
588.15
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.)
653.45
30437
Hydatid cyst of liver, total excision of, by cysto‑pericystectomy (membrane plus fibrous wall) (H) (Anaes.) (Assist.)
813.30
30438
Hydatid cyst of liver, excision of, with drainage and excision of liver tissue (Anaes.) (Assist.)
1 150.85
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.)
185.60
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.)
526.40
30441
Intra operative ultrasound for staging of intra abdominal tumours (H) (Anaes.)
136.25
30442
Choledochoscopy in conjunction with another procedure (H) (Anaes.)
185.60
30443
Cholecystectomy (H) (Anaes.) (Assist.)
739.35
30445
Laparoscopic cholecystectomy (H) (Anaes.) (Assist.)
739.35
30446
Laparoscopic cholecystectomy when procedure is completed by laparotomy (H) (Anaes.) (Assist.)
739.35
30448
Laparoscopic cholecystectomy, involving removal of common duct calculi via the cystic duct (H) (Anaes.) (Assist.)
972.90
30449
Laparoscopic cholecystectomy with removal of common duct calculi via laparoscopic choledochotomy (H) (Anaes.) (Assist.)
1 081.85
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.)
524.40
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.)
267.65
30452
Choledochoscopy with balloon dilatation of a stricture or passage of stent or extraction of calculi (H) (Anaes.) (Assist.)
377.50
30454
Choledochotomy (with or without cholecystectomy), with or without removal of calculi (H) (Anaes.) (Assist.)
862.50
30455
Choledochotomy (with or without cholecystectomy), with removal of calculi including biliary intestinal anastomosis (H) (Anaes.) (Assist.)
1 014.05
30457
Choledochotomy, intrahepatic, involving removal of intrahepatic bile duct calculi (Anaes.) (Assist.)
1 379.50
30458
Transduodenal operation on sphincter of Oddi, involving one or more of, removal of calculi, sphincterotomy, sphincteroplasty, biopsy, local excision of peri‑ampullary or duodenal tumour, sphincteroplasty of the pancreatic duct, pancreatic duct septoplasty, with or without choledochotomy (H) (Anaes.) (Assist.)
1 014.05
30460
Cholecystoduodenostomy, cholecystoenterostomy, choledochojejunostomy or Roux‑en‑Y as a bypass procedure when no prior biliary surgery performed (H) (Anaes.) (Assist.)
862.50
30461
Radical resection of porta hepatis with biliary‑enteric anastomoses, other than a service associated with a service to which item 30443, 30454, 30455, 30458 or 30460 applies (H) (Anaes.) (Assist.)
1 478.40
30463
Radical resection of common hepatic duct and right and left hepatic ducts, with 2 duct anastomoses (H) (Anaes.) (Assist.)
1 815.20
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.)
2 178.25
30466
Intrahepatic biliary bypass of left hepatic ductal system by Roux‑en‑Y loop to peripheral ductal system (H) (Anaes.) (Assist.)
1 256.05
30467
Intrahepatic bypass of right hepatic ductal system by Roux‑en‑Y loop to peripheral ductal system (H) (Anaes.) (Assist.)
1 553.70
30469
Biliary stricture, repair of, after one or more operations on the biliary tree (Anaes.) (Assist.)
1 720.90
30472
Hepatic or common bile duct, repair of, as the primary procedure after partial or total transection of bile duct or ducts (Anaes.) (Assist.)
929.35
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 30476 or 30478 applies (Anaes.)
177.10
30475
Endoscopy with balloon dilatation of gastric or gastroduodenal stricture (Anaes.)
320.25
30476
Oesophagoscopy (other than a service to which item 41816 or 41822 applies), gastroscopy, duodenoscopy or panendoscopy (one or more such procedures), with endoscopic sclerosing injection or banding of oesophageal or gastric varices, other than a service associated with a service to which item 30473 or 30478 applies (Anaes.)
245.55
30478
Oesophagoscopy (other than a service to which item 41816, 41822 or 41825 applies), gastroscopy, duodenoscopy or panendoscopy (one or more such procedures), with one or more of the following endoscopic procedures—polypectomy, removal of foreign body, diathermy, heater probe or laser coagulation, or sclerosing injection of bleeding upper gastrointestinal lesions, other than a service associated with a service to which item 30473 or 30476 applies (Anaes.)
245.55
30479
Endoscopy with laser therapy or argon plasma coagulation, for the treatment of neoplasia, benign vascular lesions, strictures of the gastrointestinal tract, tumorous overgrowth through or over oesophageal stents, peptic ulcers, angiodysplasia, gastric antral vascular ectasia (GAVE) or post‑polypectomy bleeding, one or more of (Anaes.)
476.10
30481
Percutaneous gastrostomy (initial procedure), including any associated imaging services (Anaes.)
357.00
30482
Percutaneous gastrostomy (repeat procedure), including any associated imaging services (Anaes.)
253.85
30483
Gastrostomy button, non‑endoscopic insertion of, or non‑endoscopic replacement of (Anaes.)
177.05
30484
Endoscopic retrograde cholangio‑pancreatography (Anaes.)
364.90
30485
Endoscopic sphincterotomy with or without extraction of stones from common bile duct (Anaes.)
563.30
30487
Small bowel intubation with biopsy, as an independent procedure (Anaes.)
180.90
30488
Small bowel intubation—as an independent procedure (Anaes.)
90.00
30490
Oesophageal prosthesis, insertion of, including endoscopy and dilatation (Anaes.)
526.40
30491
Bile duct, endoscopic stenting of (including endoscopy and dilatation) (Anaes.)
555.35
30492
Bile duct, percutaneous stenting of (including dilatation when performed), using interventional imaging techniques (H) (Anaes.)
787.30
30493
Biliary manometry (Anaes.)
333.20
30494
Endoscopic biliary dilatation (H) (Anaes.)
420.50
30495
Percutaneous biliary dilatation for biliary stricture using interventional imaging techniques (H) (Anaes.)
787.30
30496
Vagotomy, truncal or selective, with or without pyloroplasty or gastroenterostomy (Anaes.) (Assist.)
588.15
30497
Vagotomy and antrectomy (H) (Anaes.) (Assist.)
701.30
30499
Vagotomy, highly selective (H) (Anaes.) (Assist.)
834.05
30500
Vagotomy, highly selective with duodenoplasty for peptic stricture (Anaes.) (Assist.)
893.10
30502
Vagotomy, highly selective, with dilatation of pylorus (H) (Anaes.) (Assist.)
985.70
30503
Vagotomy or antrectomy, or both, for peptic ulcer following previous operation for peptic ulcer (Anaes.) (Assist.)
1 103.80
30505
Bleeding peptic ulcer, control of, involving suture of bleeding point or wedge excision (H) (Anaes.) (Assist.)
551.85
30506
Bleeding peptic ulcer, control of, involving suture of bleeding point or wedge excision, and vagotomy and pyloroplasty or gastroenterostomy (H) (Anaes.) (Assist.)
965.75
30508
Bleeding peptic ulcer, control of, involving suture of bleeding point or wedge excision, and highly selective vagotomy (H) (Anaes.) (Assist.)
1 016.55
30509
Bleeding peptic ulcer, control of, involving gastric resection (other than wedge resection) (Anaes.) (Assist.)
1 016.55
30515
Gastroenterostomy (including gastroduodenostomy) or enterocolostomy or enteroenterostomy, not being a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)
704.35
30517
Gastroenterostomy, pyloroplasty or gastroduodenostomy, reconstruction of (H) (Anaes.) (Assist.)
922.20
30518
Partial gastrectomy, not being a service associated with a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)
987.50
30520
Gastric tumour, removal of, by local excision, other than a service to which item 30518 applies (H) (Anaes.) (Assist.)
675.35
30521
Gastrectomy, total, for benign disease (H) (Anaes.) (Assist.)
1 444.90
30523
Gastrectomy, sub‑total radical, for carcinoma (including splenectomy when performed) (H) (Anaes.) (Assist.)
1 510.10
30524
Gastrectomy, total radical, for carcinoma (including extended node dissection and distal pancreatectomy and splenectomy when performed) (H) (Anaes.) (Assist.)
1 662.65
30526
Gastrectomy, total, and including lower oesophagus, performed by left thoraco‑abdominal incision or opening of diaphragmatic hiatus (including splenectomy when performed) (H) (Anaes.) (Assist.)
2 156.35
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.)
871.30
30529
Antireflux operation by fundoplasty, with oesophagoplasty for stricture or short oesophagus (H) (Anaes.) (Assist.)
1 306.90
30530
Antireflux operation by cardiopexy, with or without fundoplasty (H) (Anaes.) (Assist.)
784.20
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.)
900.45
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.)
1 071.00
30535
Oesophagectomy with gastric reconstruction by abdominal mobilisation and thoracotomy (H) (Anaes.) (Assist.)
1 696.65
30536
Oesophagectomy involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest—one surgeon (H) (Anaes.) (Assist.)
1 720.90
30538
Oesophagectomy involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest—conjoint surgery, principal surgeon (including after‑care) (H) (Anaes.) (Assist.)
1 190.80
30539
Oesophagectomy involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest—conjoint surgery, co‑surgeon (H) (Assist.)
871.30
30541
Oesophagectomy, by trans‑hiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement—one surgeon (H) (Anaes.) (Assist.)
1 517.50
30542
Oesophagectomy, by trans‑hiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement—conjoint surgery, principal surgeon (including after‑care) (H) (Anaes.) (Assist.)
1 031.10
30544
Oesophagectomy, by trans‑hiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement—conjoint surgery, co‑surgeon (H) (Assist.)
755.20
30545
Oesophagectomy with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis)—one surgeon (H) (Anaes.) (Assist.)
1 837.10
30547
Oesophagectomy with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis)—conjoint surgery, principal surgeon (including after‑care) (Anaes.) (Assist.)
1 263.35
30548
Oesophagectomy with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis)—conjoint surgery, co‑surgeon (Assist.)
943.80
30550
Oesophagectomy with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck)—one surgeon (H) (Anaes.) (Assist.)
2 062.20
30551
Oesophagectomy with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck)—conjoint surgery, principal surgeon (including after‑care) (H) (Anaes.) (Assist.)
1 423.15
30553
Oesophagectomy with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck)—conjoint surgery, co‑surgeon (Assist.)
1 052.65
30554
Oesophagectomy with reconstruction by free jejunal graft—one surgeon (H) (Anaes.) (Assist.)
2 294.45
30556
Oesophagectomy with reconstruction by free jejunal graft—conjoint surgery, principal surgeon (including after‑care) (H) (Anaes.) (Assist.)
1 582.80
30557
Oesophagectomy with reconstruction by free jejunal graft—conjoint surgery, co‑surgeon (H) (Assist.)
1 169.00
30559
Oesophagus, local excision for tumour of (Anaes.) (Assist.)
849.55
30560
Oesophageal perforation, repair of, by thoracotomy (H) (Anaes.) (Assist.)
943.80
30562
Enterostomy or colostomy, closure of—not involving resection of bowel (H) (Anaes.) (Assist.)
595.00
30563
Colostomy or ileostomy, refashioning of (Anaes.) (Assist.)
595.00
30564
Small bowel strictureplasty for chronic inflammatory bowel disease (H) (Anaes.) (Assist.)
772.30
30565
Small intestine, resection of, without anastomosis (including formation of stoma) (H) (Anaes.) (Assist.)
871.30
30566
Small intestine, resection of, with anastomosis (H) (Anaes.) (Assist.)
967.85
30568
Intraoperative enterotomy for visualisation of the small intestine by endoscopy (H) (Anaes.) (Assist.)
726.05
30569
Endoscopic examination of small bowel with flexible endoscope passed at laparotomy, with or without biopsies (H) (Anaes.) (Assist.)
370.20
30571
Appendicectomy, other than a service to which item 30574 applies (H) (Anaes.) (Assist.)
445.40
30572
Laparoscopic appendicectomy (H) (Anaes.) (Assist.)
445.40
30574
Appendicectomy, when performed in conjunction with another intra‑abdominal procedure through the same incision (H) (Anaes.)
123.25
30575
Pancreatic abscess, laparotomy and external drainage of, not requiring retro‑pancreatic dissection (H) (Anaes.) (Assist.)
512.70
30577
Pancreatic necrosectomy for pancreatic necrosis or abscess formation requiring major pancreatic or retro‑pancreatic dissection, excluding after‑care (H) (Anaes.) (Assist.)
1 089.15
30578
Endocrine tumour, exploration of pancreas or duodenum, followed by local excision of pancreatic tumour (H) (Anaes.) (Assist.)
1 147.20
30580
Endocrine tumour, exploration of pancreas or duodenum, followed by local excision of duodenal tumour (H) (Anaes.) (Assist.)
1 045.40
30581
Endocrine tumour, exploration of pancreas or duodenum for, but no tumour found (H) (Anaes.) (Assist.)
762.35
30583
Distal pancreatectomy (H) (Anaes.) (Assist.)
1 194.25
30584
Pancreatico‑duodenectomy, Whipple’s operation, with or without preservation of pylorus (H) (Anaes.) (Assist.)
1 762.75
30586
Pancreatic cyst‑anastomosis to stomach or duodenum—by open or endoscopic means (H) (Anaes.) (Assist.)
701.30
30587
Pancreatic cyst, anastomosis to Roux loop of jejunum (H) (Anaes.) (Assist.)
726.05
30589
Pancreatico‑jejunostomy for pancreatitis or trauma (H) (Anaes.) (Assist.)
1 251.10
30590
Pancreatico‑jejunostomy following previous pancreatic surgery (H) (Anaes.) (Assist.)
1 379.50
30593
Pancreatectomy, near total or total (including duodenum), with or without splenectomy (Anaes.) (Assist.)
1 887.75
30594
Pancreatectomy for pancreatitis following previously attempted drainage procedure or partial resection (H) (Anaes.) (Assist.)
2 178.25
30596
Splenorrhaphy or partial splenectomy (H) (Anaes.) (Assist.)
897.30
30597
Splenectomy (H) (Anaes.) (Assist.)
720.20
30599
Splenectomy, for massive spleen (weighing more than 1 500 gms) or involving thoraco‑abdominal incision (H) (Anaes.) (Assist.)
1 306.90
30600
Diaphragmatic hernia, traumatic, repair of (H) (Anaes.) (Assist.)
777.10
30601
Diaphragmatic hernia, congenital, repair of, by thoracic or abdominal approach, not being a service to which any of items 31569 to 31581 apply (H) (Anaes.) (Assist.)
957.30
30602
Portal hypertension, porto‑caval shunt for (H) (Anaes.) (Assist.)
1 553.70
30603
Portal hypertension, meso‑caval shunt for (Anaes.) (Assist.)
1 640.90
30605
Portal hypertension, selective spleno‑renal shunt for (H) (Anaes.) (Assist.)
1 865.95
30606
Portal hypertension, oesophageal transection via stapler or oversew of gastric varices with or without devascularisation (H) (Anaes.) (Assist.)
1 110.80
30609
Femoral or inguinal hernia, laparoscopic repair of, other than a service associated with a service to which item 30612 or 30614 applies (H) (Anaes.) (Assist.)
464.50
30612
Femoral or inguinal hernia or infantile hydrocele, repair of, other than a service to which item 30403 or 30615 applies (G) (H) (Anaes.) (Assist.)
356.35
30614
Femoral or inguinal hernia or infantile hydrocele, repair of, other than a service to which item 30403 or 30615 applies (S) (H) (Anaes.) (Assist.)
464.50
30615
Strangulated, incarcerated or obstructed hernia, repair of, without bowel resection (H) (Anaes.) (Assist.)
521.25
30616
Umbilical, epigastric or linea alba hernia, repair of, in a person under 10 years of age (G) (H) (Anaes.)
265.30
30617
Umbilical, epigastric or linea alba hernia, repair of, in a person under 10 years of age (S) (H) (Anaes.)
356.35
30620
Umbilical, epigastric or linea alba hernia, repair of, in a person 10 years of age or over (G) (H) (Anaes.) (Assist.)
299.45
30621
Umbilical, epigastric or linea alba hernia, repair of, in a person 10 years of age or over (S) (H) (Anaes.) (Assist.)
407.50
30628
Hydrocele, tapping of
35.60
30631
Hydrocele, removal of, other than a service associated with a service to which items 30638, 30641 and 30644 apply (Anaes.)
236.65
30634
Varicocele, surgical correction of, other than a service associated with a service to which items 30638, 30641 and 30644 apply—one procedure (G) (H) (Anaes.) (Assist.)
235.05
30635
Varicocele, surgical correction of, other than a service associated with a service to which items 30638, 30641 and 30644 apply—one procedure (S) (H) (Anaes.) (Assist.)
291.80
30638
Orchidectomy, simple or subcapsular, unilateral with or without insertion of testicular prosthesis (G) (H) (Anaes.) (Assist.)
299.45
30641
Orchidectomy, simple or subcapsular, unilateral with or without insertion of testicular prosthesis (S) (H) (Anaes.) (Assist.)
407.50
30644
Exploration of spermatic cord, inguinal approach, with or without testicular biopsy and with or without excision of spermatic cord and testis (H) (Anaes.) (Assist.)
521.25
30653
Circumcision of the penis, on a person under 6 months of age (Anaes.)
46.50
30656
Circumcision of the penis, on a person under 10 years of age but not less than 6 months of age (Anaes.)
108.15
30659
Circumcision of the penis, on a person 10 years of age or over (G) (Anaes.)
149.75
30660
Circumcision of the penis, on a person 10 years of age or over (S) (Anaes.)
185.60
30663
Haemorrhage, arrest of, following circumcision requiring general anaesthesia (Anaes.)
144.35
30666
Paraphimosis, 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.)
47.45
30672
Coccyx, excision of (H) (Anaes.) (Assist.)
445.40
30675
Pilonidal sinus or cyst, or sacral sinus or cyst, excision of (G) (Anaes.)
299.45
30676
Pilonidal sinus or cyst, or sacral sinus or cyst, excision of (S) (Anaes.)
379.05
30679
Pilonidal sinus, injection of sclerosant fluid under anaesthesia (Anaes.)
96.30
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.)
1 170.00
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.)
1 170.00
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.)
1 439.85
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.)
1 439.85
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.)
476.10
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 and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)
364.90
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 and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)
563.30
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 and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)
364.90
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 and other than a service associated with the routine monitoring of chronic pancreatitis (Anaes.)
563.30
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 non‑small cell lung carcinoma;
other than a service associated with another item in this Subgroup or to which items 30710, 55054 apply (Anaes.)
563.30
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 non‑small 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.)
563.30
31000
Micrographically controlled serial excision 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—6 or fewer sections (Anaes.)
580.90
31001
Micrographically controlled serial excision 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—7 to 12 sections (inclusive) (Anaes.)
726.05
31002
Micrographically controlled serial excision 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—13 or more sections (Anaes.)
871.30
31200
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), removal by surgical excision (other than by shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, other than a service:
(a) associated with a service to which item 45200, 45203 or 45206 applies; or
(b) to which another item in this Group applies
34.00
31205
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), 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 cutaneous tissue, subcutaneous tissue or mucous membrane by surgical excision (other than by shave excision); and
(c) the specimen excised is sent for histological examination;
including the excision of a specimen to confirm a malignant tumour covered by any of items 31300 to 31335 (other than a service to which item 30195 applies) (Anaes.)
95.45
31210
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), 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 cutaneous tissue, subcutaneous tissue or mucous membrane by surgical excision (other than by shave excision); and
(c) the specimen excised is sent for histological examination;
including the excision of a specimen to confirm a malignant tumour covered by any of items 31300 to 31335 (other than a service to which item 30195 applies) (Anaes.)
123.10
31215
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), 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 cutaneous tissue, subcutaneous tissue or mucous membrane by surgical excision (other than by shave excision); and
(c) the specimen excised is sent for histological examination;
including the excision of a specimen to confirm a malignant tumour covered by any of items 31300 to 31335 (other than a service to which item 30195 applies) (Anaes.)
143.55
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 up to 10 lesions and suture, if:
(a) the size of each lesion is not more 10 mm in diameter; and
(b) each removal is from cutaneous tissue, subcutaneous tissue or mucous membrane by surgical excision (other than by shave excision); and
(c) all of the specimens excised are sent for histological examination;
including excisions to confirm a malignant tumour covered by any of items 31300 to 31335 (other than a service to which item 30195 applies) (Anaes.)
214.55
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 and suture, if:
(a) the size of each lesion is not more than 10 mm in diameter; and
(b) each removal is from cutaneous tissue, subcutaneous tissue or mucous membrane by surgical excision (other than by shave excision); and
(c) all of the specimens excised are sent for histological examination;
including excisions to confirm a malignant tumour covered by any of items 31300 to 31335 (other than a service to which item 30195 applies) (Anaes.)
381.30
31230
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), removal by surgical excision (other than by shave excision) and suture from nose, eyelid, lip, ear, digit or genitalia, including excision to establish the diagnosis of tumours covered by items 31300 to 31335—if the specimen excised is sent for histological examination (other than a service to which item 30195 applies) (Anaes.)
168.05
31235
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), 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 the face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle) by surgical excision (other than by shave excision); and
(c) the specimen excised is sent for histological examination;
including the excision of a specimen to confirm a malignant tumour covered by any of items 31300 to 31335 (other than a service to which item 30195 applies) (Anaes.)
143.55
31240
Tumour (other than viral verrucae (common warts) and seborrheic keratoses), cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), removal by surgical excision (other than by shave excision) and suture from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), including excision to establish the diagnosis of tumours covered by items 31300 to 31335, lesion size more than 10 mm in diameter—if the specimen excised is sent for histological examination (other than a service to which item 30195 applies) (Anaes.)
168.05
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.)
369.00
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.)
369.00
31255
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from nose, eyelid, lip, ear, digit or genitalia, if:
(a) the carcinoma is not more than 10 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
221.35
31256
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from nose, eyelid, lip, ear, digit or genitalia, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was not more than 10 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
221.35
31257
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from nose, eyelid, lip, ear, digit or genitalia, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was not more than 10 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
221.35
31258
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from nose, eyelid, lip, ear, digit or genitalia, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is not more than 10 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed;
other than a service to which item 31295 applies (Anaes.)
221.35
31260
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from nose, eyelid, lip, ear, digit or genitalia, if:
(a) the carcinoma is more than 10 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
315.65
31261
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from nose, eyelid, lip, ear, digit or genitalia, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 10 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
315.65
31262
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from nose, eyelid, lip, ear, digit or genitalia, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 10 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
315.65
31263
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from nose, eyelid, lip, ear, digit or genitalia, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is more than 10 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed;
other than a service to which item 31295 applies (Anaes.)
315.65
31265
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from the face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), if:
(a) the carcinoma is not more than 10 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
184.50
31266
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was not more than 10 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
184.50
31267
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was not more than 10 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
184.50
31268
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is not more than 10 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed;
other than a service to which item 31295 applies (Anaes.)
184.50
31270
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), if:
(a) the carcinoma is more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
258.25
31271
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
258.25
31272
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
258.25
31273
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed;
other than a service to which item 31295 applies (Anaes.)
258.25
31275
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), if:
(a) the carcinoma is more than 20 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
299.25
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
31276
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 20 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
299.25
31277
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 20 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
299.25
31278
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is more than 20 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed;
other than a service to which item 31295 applies (Anaes.)
299.25
31280
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from an area of the body not covered by item 31255 or 31265, if:
(a) the carcinoma is not more than 10 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
155.85
31281
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from an area of the body not covered by item 31255 or 31265, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was not more than 10 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
156.40
31282
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from an area of the body not covered by item 31255 or 31265, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was not more than 10 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
156.40
31283
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from an area of the body not covered by item 31255 or 31265, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is not more than 10 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
156.40
31285
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from an area of the body not covered by item 31260 or 31270, if:
(a) the carcinoma is more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than by shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
212.95
31286
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from an area of the body not covered by item 31260 or 31270, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
212.95
31287
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from an area of the body not covered by item 31260 or 31270, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
212.95
31288
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from an area of the body not covered by item 31260 or 31270, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is more than 10 mm and not more than 20 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
212.95
31290
Basal cell carcinoma or squamous cell carcinoma (including keratocanthoma), removal of, from an area of the body not covered by item 31260 or 31275, if:
(a) the carcinoma is more than 20 mm in diameter; and
(b) the removal is by therapeutic surgical excision (other than shave excision) and suture; and
(c) the initial specimen removed is sent for histological examination and malignancy is confirmed
(Anaes.)
245.90
31291
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from an area of the body not covered by item 31260 or 31275, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 20 mm in diameter; and
(b) the removal is performed by the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
245.90
31292
Basal cell carcinoma or squamous cell carcinoma, residual, removal of, from an area of the body not covered by item 31260 or 31275, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was more than 20 mm in diameter; and
(b) the removal is performed by a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision (other than shave excision) and suture; and
(d) the specimen excised is sent for histological examination
(Anaes.)
245.90
31293
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from an area of the body not covered by item 31260 or 31275, following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the carcinoma is more than 20 mm in diameter; and
(b) the removal is by surgical excision (other than shave excision) and suture; and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
245.90
31295
Basal cell carcinoma or squamous cell carcinoma, recurrent, removal of, from the head or neck (anterior to the sternomastoid muscles), following the removal of a previous basal cell carcinoma or squamous cell carcinoma at that site, if:
(a) the previous carcinoma was treated by previous surgery, serial cautery and curettage, radiotherapy or 2 prolonged freeze and thaw cycles of liquid nitrogen therapy; and
(b) the removal is performed by:
(i) a specialist in the practice of his or her specialty; or
(ii) a practitioner other than the practitioner who removed the previous carcinoma; and
(c) the removal is by surgical excision and suture; and
(d) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
292.85
31300
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle, removal of, from nose, eyelid, lip, ear, digit or genitalia, and suture, if:
(a) the tumour size is not more than 10 mm in diameter; and
(b) the removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
319.90
31305
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle‑removal from nose, eyelid, lip, ear, digit or genitalia, tumour size more than 10 mm in diameter, and suture, if:
(a) removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(b) the specimen excised is sent for histological examination and confirmation of malignancy has been obtained
(Anaes.)
393.50
31310
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle, removal of, from face, neck (anterior to sternomastoid muscles) or lower leg (mid calf to ankle), and suture, if:
(a) the tumour size is not more than 10 mm in diameter; and
(b) the removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
278.65
31315
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle, removal of, from face, neck (anterior to sternomastoid muscles) or lower leg (mid calf to ankle), and suture, if:
(a) the tumour size is more than 10 mm but not more than 20 mm in diameter; and
(b) the removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
352.50
31320
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle, removal of, from face, neck (anterior to sternomastoid muscles) or lower leg (mid calf to ankle), and suture, if:
(a) the tumour size is more than 20 mm in diameter; and
(b) the removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
393.50
31325
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle, removal of, from an area of the body not covered by items 31300 and 31310, and suture, if:
(a) the tumour size is not more than 10 mm in diameter; and
(b) the removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
270.55
31330
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle, removal of, from an area of the body not covered by items 31305 and 31310, and suture, if:
(a) the tumour size is more than 10 mm but not more than 20 mm in diameter; and
(b) the removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and malignancy is confirmed
(Anaes.)
319.90
31335
Malignant melanoma, appendageal carcinoma, malignant fibrous tumour of skin, merkel cell carcinoma of skin or Hutchinson’s melanotic freckle‑removal from areas of the body not covered by items 31305 and 31320, and suture, if:
(a) the tumour size more than 20 mm in diameter; and
(b) removal is by definitive surgical excision (with an adequate margin and as a result, no further surgery is indicated at the site of excision); and
(c) the specimen excised is sent for histological examination and confirmation of malignancy has been obtained
(Anaes.)
369.00
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 any of items 31255 to 31335 is excised
(Anaes.)
Amount under clause 2.44.5
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) sub‑fascial; and
(b) the specimen excised is sent for histological confirmation of diagnosis
(Anaes.)
210.95
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
(Anaes.)
210.95
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, 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.)
433.35
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.)
714.45
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.)
261.05
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.)
301.35
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.)
502.15
31409
Parapharyngeal tumour, excision of, by cervical approach (H) (Anaes.) (Assist.)
1 560.15
31412
Recurrent or persistent parapharyngeal tumour, excision of, by cervical approach (H) (Anaes.) (Assist.)
1 921.75
31420
Lymph node of neck, biopsy of (Anaes.)
183.90
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 (Anaes.) (Assist.)
401.75
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.)
803.45
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, sternocleido‑mastoid muscle or spinal accessory nerve (H) (Anaes.) (Assist.)
1 252.10
31432
Lymph nodes of neck, bilateral selective dissection of levels I, II and III (bilateral supraomohyoid dissections) (H) (Anaes.) (Assist.)
1 339.15
31435
Lymph nodes of neck, comprehensive dissection of all 5 lymph node levels on one side of the neck (H) (Anaes.) (Assist.)
984.30
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, sternocleido‑mastoid muscle, or spinal accessory nerve (H) (Anaes.) (Assist.)
1 560.15
31450
Laparoscopic division of adhesions, as an independent procedure, if the time taken is 1 hour or less (H) (Anaes.) (Assist.)
406.65
31452
Laparoscopic division of adhesions, as an independent procedure, if the time taken is more than 1 hour (H) (Anaes.) (Assist.)
711.50
31454
Laparoscopy with drainage of pus, bile or blood, as an independent procedure (H) (Anaes.) (Assist.)
563.30
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.)
245.55
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.)
294.65
31460
Percutaneous gastrostomy tube, jejunal extension to, including any associated imaging services (H) (Anaes.) (Assist.)
357.00
31462
Operative feeding jejunostomy performed in conjunction with major upper gastro‑intestinal resection (H) (Anaes.) (Assist.)
521.25
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.)
871.30
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.)
1 306.95
31468
Para‑oesophageal hiatus hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication (H) (Anaes.) (Assist.)
1 435.85
31470
Laparoscopic splenectomy (H) (Anaes.) (Assist.)
720.20
31472
Cholecystoduodenostomy, cholecystoenterostomy, choledochojejunostomy or Roux‑en‑y as a bypass procedure, if prior biliary surgery has been performed (H) (Anaes.) (Assist.)
1 169.80
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.)
260.05
31503
Breast, benign lesion more than 50 mm in diameter, excision of (Anaes.) (Assist.)
346.75
31506
Breast, abnormality detected by mammography or ultrasound, if guidewire or other localisation procedure is performed, excision biopsy of (H) (Anaes.) (Assist.)
390.10
31509
Breast, malignant tumour, open surgical biopsy of, with or without frozen section histology (Anaes.)
346.75
31512
Breast, malignant tumour, complete local excision of, with or without frozen section histology (H) (Anaes.) (Assist.)
650.15
31515
Breast, tumour site, re‑excision of, following open biopsy or incomplete excision of malignant tumour (H) (Anaes.) (Assist.)
436.15
31519
Breast, total mastectomy (H) (Anaes.) (Assist.)
736.05
31524
Breast, subcutaneous mastectomy (H) (Anaes.) (Assist.)
1 040.25
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.)
520.00
31530
Breast, biopsy of solid tumour or tissue of, using a vacuum‑assisted 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 pre‑operative localisation of lesion, if performed, other than a service associated with a service to which item 31539, 31545 or 31548 applies
595.65
31533
Fine needle aspiration of an impalpable breast lesion detected by mammography or ultrasound, imaging guided—but not including imaging (Anaes.)
137.90
31536
Breast, preoperative localisation of lesion of, by hookwire or similar device, using interventional imaging techniques, but not including imaging—other than a service associated with a service to which item 31539, 31542 or 31545 applies (Anaes.)
189.40
31539
Breast, biopsy of solid tumour or tissue of, using a bore‑enbloc stereotactic biopsy, for histological examination, conducted by a qualified surgeon, if imaging has demonstrated an impalpable lesion of less than 15 mm in diameter, other than a service associated with a service to which item 31530, 31536 or 31548 applies (H) (Anaes.)
398.80
31542
Breast, initial guidewire localisation of lesion, by hookwire or similar device, conducted by a qualified radiologist, using interventional imaging techniques before a bore‑enbloc stereotactic biopsy, including imaging—other than a service associated with a service to which item 31536 applies (Anaes.)
196.95
31545
Breast, biopsy of solid tumour or tissue of, using a bore‑enbloc stereotactic biopsy, for histological examination, conducted by a qualified surgeon, if imaging has demonstrated an impalpable lesion of less than 15 mm in diameter, including initial guidewire localisation of lesion, by hookwire or similar device, using interventional imaging techniques and including imaging—other than a service associated with a service to which item 31530, 31536 or 31548 applies (Anaes.)
595.65
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, 31539 or 31545 applies (Anaes.)
137.90
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 after‑care (Anaes.)
216.75
31554
Breast, microdochotomy of, for benign or malignant condition (H) (Anaes.) (Assist.)
433.50
31557
Breast central ducts, excision of, for benign condition (Anaes.) (Assist.)
346.75
31560
Accessory breast tissue, excision of (Anaes.) (Assist.)
346.75
31563
Inverted nipple, surgical eversion of (Anaes.)
259.75
31566
Accessory nipple, excision of (Anaes.)
129.95
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.)
849.55
31572
Gastric bypass by Roux‑en‑Y 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.)
1 045.40
31575
Sleeve gastrectomy, with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (H) (Anaes.) (Assist.)
849.55
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.)
849.55
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.)
1 045.40
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.)
1 539.10
31587
Adjustment of gastric band as an independent procedure including any associated consultation
97.95
31590
Adjustment of gastric band reservoir, repair, revision or replacement of (Anaes.) (Assist.)
251.70
Subdivision C—Subgroups 2 and 3 of Group T8
2.44.13 Meaning of foreign body in items 35360 to 35363
For items 35360 to 35363, foreign body does not include an instrument inserted for the purpose of a service being rendered.
2.44.14 Application of items 32500 to 32517 and 35321
Items 32500 to 32517 and 35321 do not apply to the services mentioned in those items if the services are delivered by:
(a) endovenous laser treatment; or
(b) radiofrequency diathermy; or
(c) radiofrequency ablation for varicose veins.
2.44.15 Application of items 35404, 35406 and 35408
(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.
(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.
2.44.15A Sacral nerve stimulation
Sacral nerve stimulation under items 32213 to 32218 for faecal incontinence is contraindicated in:
(a) patients under 18 years of age; and
(b) patients 18 years of age or older who:
(i) are medically unfit for surgery; or
(ii) are pregnant or planning pregnancy; or
(iii) have irritable bowel syndrome; or
(iv) have congenital anorectal malformations; or
(v) have active anal abscesses or fistulas; or
(vi) have anorectal organic bowel disease, including cancer; or
(vii) have functional effects of previous pelvic irradiation; or
(viii) have congenital or acquired malformations of the sacrum; or
(ix) have had rectal or anal surgery within the previous 12 months.
2.44.15B Artificial bowel sphincter
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.
Group T8—Surgical operations
Item
Description
Fee ($)
Subgroup 2—Colorectal
32000
Large intestine, resection of, without anastomosis, including right hemicolectomy (including formation of stoma) (H) (Anaes.) (Assist.)
1 031.35
32003
Large intestine, resection of, with anastomosis, including right hemicolectomy (H) (Anaes.) (Assist.)
1 078.80
32004
Large intestine, sub‑total 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.)
1 150.35
32005
Large intestine, sub‑total 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.)
1 299.55
32006
Left hemicolectomy, including the descending and sigmoid colon (including formation of stoma) (H) (Anaes.) (Assist.)
1 150.35
32009
Total colectomy and ileostomy (H) (Anaes.) (Assist.)
1 364.60
32012
Total colectomy and ileo‑rectal anastomosis (H) (Anaes.) (Assist.)
1 507.40
32015
Total colectomy with excision of rectum and ileostomy—one surgeon (H) (Anaes.) (Assist.)
1 852.50
32018
Total colectomy with excision of rectum and ileostomy, combined synchronous operation—abdominal resection (including after‑care) (H) (Anaes.) (Assist.)
1 570.85
32021
Total colectomy with excision of rectum and ileostomy, combined synchronous operation—perineal resection (H) (Assist.)
563.30
32023
Endoscopic insertion of stent or stents for large bowel obstruction, stricture or stenosis, including colonoscopy and any image intensification, where the obstruction is due to:
(a) a pre‑diagnosed colorectal cancer, or cancer of an organ adjacent to the bowel; or
(b) an unknown diagnosis (H) (Anaes.)
555.35
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.)
1 364.60
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.)
1 825.30
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.)
1 965.65
32028
Rectum, low or ultra low restorative resection, with peranal sutured coloanal anastomosis, with or without covering stoma (H) (Anaes.) (Assist.)
2 106.20
32029
Colonic reservoir, construction of, being a service associated with a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)
421.20
32030
Rectosigmoidectomy—(Hartmann’s operation) (H) (Anaes.) (Assist.)
1 031.35
32033
Restoration of bowel following Hartmann’s or similar operation, including dismantling of the stoma (H) (Anaes.) (Assist.)
1 507.40
32036
Sacrococcygeal and presacral tumour—excision of (H) (Anaes.) (Assist.)
1 911.80
32039
Rectum and anus, abdomino‑perineal resection of—one surgeon (H) (Anaes.) (Assist.)
1 535.05
32042
Rectum and anus, abdomino‑perineal resection of, combined synchronous operation, abdominal resection (H) (Anaes.) (Assist.)
1 293.15
32045
Rectum and anus, abdomino‑perineal resection of, combined synchronous operation—perineal resection (H) (Assist.)
483.95
32046
Rectum and anus, abdomino‑perineal resection of, combined synchronous operation—perineal resection if the perineal surgeon also provides assistance to the abdominal surgeon (H) (Assist.)
747.90
32047
Perineal proctectomy (H) (Anaes.) (Assist.)
871.30
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.)
2 316.60
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 after‑care) (H) (Anaes.) (Assist.)
2 126.20
32057
Total colectomy with excision of rectum and ileoanal anastomosis with formation of ileal reservoir—conjoint surgery, perineal surgeon (H) (Assist.)
563.30
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.)
2 316.60
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 after‑care) (H) (Anaes.) (Assist.)
2 126.20
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.)
563.30
32069
Ileostomy reservoir, continent type, creation of, including conversion of existing ileostomy, if appropriate (H) (Anaes.)
1 713.65
32072
Sigmoidoscopic examination (with rigid sigmoidoscope), with or without biopsy
47.85
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.)
75.05
32078
Sigmoidoscopic examination with diathermy or resection of one or more polyps, if the time taken is less than or equal to 45 minutes (Anaes.)
168.55
32081
Sigmoidoscopic examination with diathermy or resection of one or more polyps, if the time taken is greater than 45 minutes (Anaes.)
231.45
32084
Flexible fibreoptic sigmoidoscopy or fibreoptic colonoscopy up to the hepatic flexure, with or without biopsy (Anaes.)
111.35
32087
Endoscopic examination of the colon up to the hepatic flexure by flexible fibreoptic sigmoidoscopy or fibreoptic colonoscopy for the removal of one or more polyps or the treatment of radiation proctitis, angiodysplasia or post‑polypectomy bleeding by argon plasma coagulation, one or more of—other than a service to which item 32078 applies (Anaes.)
204.70
32090
Fibreoptic colonoscopy—examination of colon beyond the hepatic flexure with or without biopsy (Anaes.)
334.35
32093
Endoscopic examination of the colon beyond the hepatic flexure by fibreoptic colonoscopy for the removal of one or more polyps, or the treatment of radiation proctitis, angiodysplasia or post‑polypectomy bleeding by argon plasma coagulation, one or more of (Anaes.)
469.20
32094
Endoscopic dilatation of colorectal strictures including colonoscopy (H) (Anaes.)
551.85
32095
Endoscopic examination of small bowel with flexible endoscope passed by stoma, with or without biopsies (Anaes.)
127.80
32096
Rectal biopsy, full thickness, under general anaesthesia, or under epidural or spinal (intrathecal) nerve block (H) (Anaes.) (Assist.)
256.95
32099
Rectal tumour of 5 cm or less in diameter, per anal submucosal excision of (H) (Anaes.) (Assist.)
333.20
32102
Rectal tumour of greater than 5 cm in diameter, indicated by pathological examination, per anal submucosal excision of (H) (Anaes.) (Assist.)
634.70
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.)
772.30
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.)
999.65
32105
Anorectal carcinoma—per anal full thickness excision of (Anaes.) (Assist.)
483.95
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.)
1 364.60
32108
Rectal tumour, trans‑sphincteric excision of (Kraske or similar operation) (H) (Anaes.) (Assist.)
999.65
32111
Rectal prolapse, Delorme procedure for (H) (Anaes.) (Assist.)
634.70
32112
Rectal prolapse, perineal recto‑sigmoidectomy for (H) (Anaes.) (Assist.)
772.30
32114
Rectal stricture, per anal release of (Anaes.)
174.45
32115
Rectal stricture, dilatation of (H) (Anaes.)
126.85
32117
Rectal prolapse, abdominal rectopexy of (H) (Anaes.) (Assist.)
999.65
32120
Rectal prolapse, perineal repair of (H) (Anaes.) (Assist.)
256.95
32123
Anal stricture, anoplasty for (Anaes.) (Assist.)
333.20
32126
Anal incontinence, Parks’ intersphincteric procedure for (H) (Anaes.) (Assist.)
483.95
32129
Anal sphincter, direct repair of (H) (Anaes.) (Assist.)
634.70
32131
Rectocele, transanal repair of rectocele (H) (Anaes.) (Assist.)
533.60
32132
Haemorrhoids or rectal prolapse—sclerotherapy for (Anaes.)
45.10
32135
Haemorrhoids or rectal prolapse—rubber band ligation of, with or without sclerotherapy, cryotherapy or infrared therapy for (Anaes.)
67.50
32138
Haemorrhoidectomy including excision of anal skin tags when performed (Anaes.)
367.75
32139
Haemorrhoidectomy involving third or fourth degree haemorrhoids, including excision of anal skin tags when performed (H) (Anaes.) (Assist.)
367.75
32142
Anal skin tags or anal polyps, excision of one or more of (Anaes.)
67.50
32145
Anal skin tags or anal polyps, excision of one or more of, undertaken in the operating theatre of a hospital (Anaes.)
135.05
32147
Perianal thrombosis, incision of (Anaes.)
45.10
32150
Operation for fissure‑in‑ano, including excision or sphincterotomy but excluding dilatation only (Anaes.) (Assist.)
256.95
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.)
70.10
32156
Fistula‑in‑ano, subcutaneous, excision of (Anaes.)
131.75
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.)
333.20
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.)
483.95
32165
Anal fistula, repair of by mucosal flap advancement (Anaes.) (Assist.)
634.70
32166
Anal fistula—readjustment of Seton (Anaes.)
206.20
32168
Fistula wound, review of, under general or regional anaesthetic, as an independent procedure (H) (Anaes.)
131.75
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.)
88.80
32174
Intra‑anal, perianal or ischio‑rectal abscess, drainage of (excluding after‑care) (Anaes.)
88.80
32175
Intra‑anal, perianal or ischio‑rectal abscess, draining of, performed in the operating theatre of a hospital (excluding after‑care) (H) (Anaes.)
162.65
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.)
174.25
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.)
256.95
32183
Intestinal sling procedure before radiotherapy (H) (Anaes.) (Assist.)
561.65
32186
Colonic lavage, total, intra‑operative (H) (Anaes.) (Assist.)
561.65
32200
Distal muscle, devascularisation of (Anaes.) (Assist.)
295.70
32203
Anal or perineal graciloplasty (H) (Anaes.) (Assist.)
635.00
32206
Stimulator and electrodes, insertion of, following previous graciloplasty (H) (Anaes.) (Assist.)
573.70
32209
Anal or perineal graciloplasty with insertion of stimulator and electrodes (H) (Anaes.) (Assist.)
921.95
32210
Gracilis neosphincter pacemaker, replacement of (Anaes.)
255.45
32212
Ano‑rectal application of formalin in the treatment of radiation proctitis, if performed in the operating theatre of a hospital, excluding after‑care (Anaes.)
136.25
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 non‑surgical treatment for at least 12 months
660.95
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 non‑surgical treatment for at least 12 months
334.00
32215
Sacral nerve electrode or electrodes, management, adjustment and electronic programming of the neurostimulator by a medical practitioner, to manage faecal incontinence—each day
125.40
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 non‑surgical treatment for at least 12 months;
other than a service to which item 32213 applies (H) (Anaes.)
593.55
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 non‑surgical treatment for at least 12 months
(H) (Anaes.)
156.30
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 non‑surgical treatment for at least 12 months
(H) (Anaes.)
156.30
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.)
903.90
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.)
903.90
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 after‑care)—to a maximum of 6 treatments in a 12 month period (Anaes.)
109.80
32501
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 after‑care)—if it can be demonstrated that truncal reflux in the long or short saphenous veins has been excluded by duplex examination and that a seventh or subsequent treatment (including any treatments to which item 32500 applies) is indicated in a 12 month period
109.80
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.)
267.65
32507
Varicose veins, sub‑fascial 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.)
533.60
32508
Varicose veins, complete dissection at the sapheno‑femoral junction or sapheno‑popliteal 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.)
533.60
32511
Varicose veins, complete dissection at the sapheno‑femoral junction and sapheno‑popliteal 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.)
793.30
32514
Varicose veins, ligation of the long or short saphenous vein on the same leg, with or without stripping, by re‑operation 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.)
926.80
32517
Varicose veins, ligation of the long and short saphenous veins on the same leg, with or without stripping, by re‑operation for recurrent veins in either territory—one leg—including excision or injection of either tributaries or incompetent perforating veins, or both (H) (Anaes.) (Assist.)
1 193.40
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, where 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, including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both) but not including radiofrequency diathermy or radiofrequency ablation, and not provided on the same occasion as a service described in any of items 32500, 32501, 32504 and 32507 (Anaes.)
533.60
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, where it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer, including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both) but not including radiofrequency diathermy or radiofrequency ablation, and not provided on the same occasion as a service described in any of items 32500, 32501, 32504 and 32507 (Anaes.)
793.30
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, where 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, including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both), but not including endovenous laser therapy, and not provided on the same occasion as a service described in any of items 32500, 32501, 32504 and 32507 (Anaes.)
533.60
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, where it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer, including all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both), but not including endovenous laser therapy, and not provided on the same occasion as a service described in any of items 32500, 32501, 32504 and 32507 (Anaes.)
793.30
32700
Artery of neck, bypass using vein or synthetic material (H) (Anaes.) (Assist.)
1 436.30
32703
Internal carotid artery, transection and reanastomosis of, or resection of small length and reanastomosis of—with or without endarterectomy (H) (Assist.)
1 188.20
32708
Aortic bypass for occlusive disease using a straight non‑bifurcated graft (H) (Anaes.) (Assist.)
1 421.35
32710
Aortic bypass for occlusive disease using a bifurcated graft with one or both anastomoses to the iliac arteries (H) (Anaes.) (Assist.)
1 579.30
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.)
1 737.25
32712
Ilio‑femoral bypass grafting (H) (Anaes.) (Assist.)
1 255.80
32715
Axillary or subclavian to femoral bypass grafting to one or both femoral arteries (H) (Anaes.) (Assist.)
1 255.80
32718
Femoro‑femoral or ilio‑femoral cross‑over bypass grafting (H) (Anaes.) (Assist.)
1 188.20
32721
Renal artery, bypass grafting to (H) (Anaes.) (Assist.)
1 887.35
32724
Renal arteries (both), bypass grafting to (H) (Anaes.) (Assist.)
2 143.10
32730
Mesenteric vessel (single), bypass grafting to (H) (Anaes.) (Assist.)
1 624.30
32733
Mesenteric vessels (multiple), bypass grafting to (H) (Anaes.) (Assist.)
1 887.35
32736
Inferior mesenteric artery, operation on, when performed in conjunction with another intra‑abdominal vascular operation (H) (Anaes.) (Assist.)
413.55
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.)
1 293.40
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.)
1 481.50
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.)
1 691.95
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.)
1 834.80
32751
Femoral artery bypass grafting using synthetic graft, with lower anastomosis above or below the knee (H) (Anaes.) (Assist.)
1 188.20
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.)
1 481.50
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.)
413.55
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.)
406.05
32763
Arterial bypass grafting, using vein or synthetic material, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)
1 188.20
32766
Arterial or venous anastomosis, other than a service to which another item in this Subgroup applies, as an independent procedure (H) (Anaes.) (Assist.)
789.65
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.)
273.65
33050
Bypass grafting to replace a popliteal aneurysm using vein, including harvesting vein (when it is the ipsilateral long saphenous vein) (H) (Anaes.) (Assist.)
1 455.30
33055
Bypass grafting to replace a popliteal aneurysm using a synthetic graft (H) (Anaes.) (Assist.)
1 167.05
33070
Aneurysm in the extremities, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
842.00
33075
Aneurysm in the neck, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)
1 071.05
33080
Intra‑abdominal or pelvic aneurysm, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)
1 307.45
33100
Aneurysm of common or internal carotid artery, or both, replacement by graft of vein or synthetic material (Anaes.) (Assist.)
1 436.30
33103
Thoracic aneurysm, replacement by graft (H) (Anaes.) (Assist.)
2 015.30
33109
Thoraco‑abdominal aneurysm, replacement by graft including re‑implantation of arteries (Anaes.) (Assist.)
2 436.50
33112
Suprarenal abdominal aortic aneurysm, replacement by graft including re‑implantation of arteries (H) (Anaes.) (Assist.)
2 113.10
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.)
1 421.35
33116
Infrarenal abdominal aortic aneurysm (repair), replacement by tube graft using endovascular repair procedure, excluding associated radiological services (Anaes.) (Assist.)
1 399.00
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.)
1 579.30
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.)
1 554.55
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.)
1 737.25
33124
Aneurysm of iliac artery (common, external or internal), replacement by graft—unilateral (H) (Anaes.) (Assist.)
1 210.80
33127
Aneurysms of iliac arteries (common, external or internal), replacement by graft—bilateral (Anaes.) (Assist.)
1 586.75
33130
Aneurysm of visceral artery, excision and repair by direct anastomosis or replacement by graft (H) (Anaes.) (Assist.)
1 383.65
33133
Aneurysm of visceral artery, dissection and ligation of arteries without restoration of continuity (H) (Anaes.) (Assist.)
1 037.65
33136
False aneurysm, repair of, at aortic anastomosis following previous aortic surgery (H) (Anaes.) (Assist.)
2 616.75
33139
False aneurysm, repair of, in iliac artery and restoration of arterial continuity (H) (Anaes.) (Assist.)
1 586.75
33142
False aneurysm, repair of, in femoral artery and restoration of arterial continuity (Anaes.) (Assist.)
1 481.50
33145
Ruptured thoracic aortic aneurysm, replacement by graft (H) (Anaes.) (Assist.)
2 549.20
33148
Ruptured thoraco‑abdominal aortic aneurysm, replacement by graft (H) (Anaes.) (Assist.)
3 165.80
33151
Ruptured suprarenal abdominal aortic aneurysm, replacement by graft (H) (Anaes.) (Assist.)
3 007.90
33154
Ruptured infrarenal abdominal aortic aneurysm, replacement by tube graft (H) (Anaes.) (Assist.)
2 225.90
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.)
2 481.50
33160
Ruptured infrarenal abdominal aortic aneurysm, replacement by bifurcation graft to one or both femoral arteries (H) (Anaes.) (Assist.)
2 481.50
33163
Ruptured iliac artery aneurysm, replacement by graft (H) (Anaes.) (Assist.)
2 105.70
33166
Ruptured aneurysm of visceral artery, replacement by anastomosis or graft (Anaes.) (Assist.)
2 105.70
33169
Ruptured aneurysm of visceral artery, simple ligation of (H) (Anaes.) (Assist.)
1 639.35
33172
Aneurysm of major artery, replacement by graft, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)
1 278.35
33175
Ruptured aneurysm in the extremities, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)
1 178.10
33178
Ruptured aneurysm in the neck, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)
1 498.20
33181
Ruptured intra‑abdominal or pelvic aneurysm, ligation, suture closure or excision of, without bypass grafting (H) (Anaes.) (Assist.)
1 831.70
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.)
1 135.40
33506
Innominate or subclavian artery, endarterectomy of, including closure by suture (H) (Anaes.) (Assist.)
1 270.90
33509
Aortic endarterectomy, including closure by suture, other than a service associated with another procedure on the aorta (H) (Anaes.) (Assist.)
1 421.35
33512
Aorto‑iliac 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.)
1 579.30
33515
Aorto‑femoral endarterectomy (one or both femoral arteries) or bilateral ilio‑femoral endarterectomy, including closure by suture, other than a service associated with a service to which item 33512 applies (H) (Anaes.) (Assist.)
1 737.25
33518
Iliac endarterectomy, including closure by suture, other than a service associated with another procedure on the iliac artery (Anaes.) (Assist.)
1 270.90
33521
Ilio‑femoral endarterectomy (one side), including closure by suture (H) (Anaes.) (Assist.)
1 376.10
33524
Renal artery, endarterectomy of (H) (Anaes.) (Assist.)
1 624.30
33527
Renal arteries (both), endarterectomy of (H) (Anaes.) (Assist.)
1 887.35
33530
Coeliac or superior mesenteric artery, endarterectomy of (H) (Anaes.) (Assist.)
1 624.30
33533
Coeliac and superior mesenteric artery, endarterectomy of (H) (Anaes.) (Assist.)
1 887.35
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.)
1 346.10
33539
Artery of extremities, endarterectomy of, including closure by suture (H) (Anaes.) (Assist.)
970.05
33542
Extended deep femoral endarterectomy, if the endarterectomy is at least 7 cm long (H) (Anaes.) (Assist.)
1 383.65
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.)
273.65
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.)
556.60
33551
Vein, harvesting of from leg or arm for patch when not performed through same incision as operation (H) (Anaes.) (Assist.)
273.65
33554
Endarterectomy, in conjunction with an arterial bypass operation to prepare the site for anastomosis—each site (H) (Anaes.) (Assist.)
272.40
33800
Embolus, removal of, from artery of neck (Anaes.) (Assist.)
1 180.60
33803
Embolectomy or thrombectomy, by abdominal approach, of an artery or bypass graft of trunk (H) (Anaes.) (Assist.)
1 128.05
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.)
812.15
33810
Inferior vena cava or iliac vein, closed thrombectomy by catheter via the femoral vein (Anaes.) (Assist.)
592.45
33811
Inferior vena cava or iliac vein, open removal of thrombus or tumour (H) (Anaes.) (Assist.)
1 763.80
33812
Thrombus, removal of, from femoral or other similar large vein (Anaes.) (Assist.)
932.45
33815
Major artery or vein of extremity, repair of wound of, with restoration of continuity, by lateral suture (H) (Anaes.) (Assist.)
857.30
33818
Major artery or vein of extremity, repair of wound of, with restoration of continuity, by direct anastomosis (H) (Anaes.) (Assist.)
1 000.15
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.)
1 143.00
33824
Major artery or vein of neck, repair of wound of, with restoration of continuity, by lateral suture (H) (Anaes.) (Assist.)
1 090.35
33827
Major artery or vein of neck, repair of wound of, with restoration of continuity, by direct anastomosis (H) (Anaes.) (Assist.)
1 278.35
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.)
1 466.30
33833
Major artery or vein of abdomen, repair of wound of, with restoration of continuity by lateral suture (H) (Anaes.) (Assist.)
1 331.15
33836
Major artery or vein of abdomen, repair of wound of, with restoration of continuity by direct anastomosis (H) (Anaes.) (Assist.)
1 586.75
33839
Major artery or vein of abdomen, repair of wound of, with restoration of continuity by means of interposition graft (H) (Anaes.) (Assist.)
1 857.40
33842
Artery of neck, re‑operation for bleeding or thrombosis after carotid or vertebral artery surgery (H) (Anaes.) (Assist.)
917.40
33845
Laparotomy for control of post operative bleeding or thrombosis after intra‑abdominal vascular procedure, if no other procedure is performed (H) (Anaes.) (Assist.)
639.20
33848
Extremity, re‑operation on, for control of bleeding or thrombosis after vascular procedure, if no other procedure is performed (H) (Anaes.) (Assist.)
639.20
34100
Major artery of neck, elective ligation or exploration of, other than a service associated with another vascular procedure (H) (Anaes.) (Assist.)
707.00
34103
Great artery or great vein (including subclavian, axillary, iliac, femoral or popliteal), ligation of, or exploration of, other than a service associated with another vascular procedure except those services to which item 32508, 32511, 32514 or 32517 applies (H) (Anaes.) (Assist.)
413.55
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.)
291.70
34109
Temporal artery, biopsy of (Anaes.) (Assist.)
338.35
34112
Arterio‑venous fistula of an extremity, dissection and ligation (H) (Anaes.) (Assist.)
857.30
34115
Arterio‑venous fistula of the neck, dissection and ligation (H) (Anaes.) (Assist.)
970.05
34118
Arterio‑venous fistula of the abdomen, dissection and ligation (Anaes.) (Assist.)
1 383.65
34121
Arterio‑venous fistula of an extremity, dissection and repair of, with restoration of continuity (H) (Anaes.) (Assist.)
1 105.35
34124
Arterio‑venous fistula of the neck, dissection and repair of, with restoration of continuity (H) (Anaes.) (Assist.)
1 210.80
34127
Arterio‑venous fistula of the abdomen, dissection and repair of, with restoration of continuity (H) (Anaes.) (Assist.)
1 586.75
34130
Surgically created arterio‑venous fistula of an extremity, closure of (Anaes.) (Assist.)
496.30
34133
Scalenotomy (H) (Anaes.) (Assist.)
556.60
34136
First rib, resection of portion of (H) (Anaes.) (Assist.)
894.75
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.)
894.75
34142
Coeliac artery, decompression of, for coeliac artery compression syndrome, as an independent procedure (H) (Anaes.) (Assist.)
1 105.35
34145
Popliteal artery, exploration of, for popliteal entrapment, with or without division of fibrous tissue and muscle (H) (Anaes.) (Assist.)
804.65
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.)
1 436.30
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.)
1 962.65
34154
Recurrent carotid associated tumour, resection of, with or without repair or replacement of portion of internal or common carotid arteries (Anaes.) (Assist.)
2 338.75
34157
Neck, excision of infected bypass graft, including closure of vessel or vessels (H) (Anaes.) (Assist.)
1 188.20
34160
Aorto‑duodenal fistula, repair of, by suture of aorta and repair of duodenum (H) (Anaes.) (Assist.)
2 225.90
34163
Aorto‑duodenal fistula, repair of, by insertion of aortic graft and repair of duodenum (H) (Anaes.) (Assist.)
2 857.55
34166
Aorto‑duodenal fistula, repair of, by oversewing of abdominal aorta, repair of duodenum and axillo bifemoral grafting (H) (Anaes.) (Assist.)
2 857.55
34169
Infected bypass graft from trunk, excision of, including closure of arteries (H) (Anaes.) (Assist.)
1 586.75
34172
Infected axillo‑femoral or femoro‑femoral graft, excision of, including closure of arteries (H) (Anaes.) (Assist.)
1 293.40
34175
Infected bypass graft from extremities, excision of including closure of arteries (H) (Anaes.) (Assist.)
1 188.20
34500
Arteriovenous shunt, external, insertion of (Anaes.) (Assist.)
308.40
34503
Arteriovenous anastomosis of upper or lower limb, in conjunction with another venous or arterial operation (H) (Anaes.) (Assist.)
413.55
34506
Arteriovenous shunt, external, removal of (H) (Anaes.) (Assist.)
210.45
34509
Arteriovenous anastomosis of upper or lower limb, not in conjunction with another venous or arterial operation (H) (Anaes.) (Assist.)
977.55
34512
Arteriovenous access device, insertion of (H) (Anaes.) (Assist.)
1 075.40
34515
Arteriovenous access device, thrombectomy of (H) (Anaes.) (Assist.)
767.00
34518
Stenosis of arteriovenous fistula or prosthetic arteriovenous access device, correction of (H) (Anaes.) (Assist.)
1 285.75
34521
Intra‑abdominal artery or vein, cannulation of, for infusion chemotherapy, by open operation (excluding after‑care) (H) (Anaes.) (Assist.)
789.95
34524
Arterial cannulation for infusion chemotherapy by open operation, other than a service to which item 34521 applies (excluding after‑care) (H) (Anaes.) (Assist.)
413.55
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 (Anaes.)
551.60
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 (Anaes.)
272.40
34530
Central venous line catheter, or other chemotherapy device, removal of, by open surgical procedure in the operating theatre of a hospital (Anaes.)
204.25
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 after‑care) (Anaes.) (Assist.)
1 240.65
34538
Central vein catheterisation by percutaneous technique, using subcutaneous tunnelled cuffed catheter or similar device, for the administration of haemodialysis or parenteral nutrition (Anaes.)
272.40
34539
Tunnelled cuffed catheter, or similar device, removal of, by open surgical procedure in the operating theatre of a hospital (Anaes.)
204.25
34800
Inferior vena cava, plication, ligation, or application of caval clip (Anaes.) (Assist.)
812.15
34803
Inferior vena cava, reconstruction of or bypass by vein or synthetic material (H) (Anaes.) (Assist.)
1 789.85
34806
Cross leg bypass grafting, saphenous to iliac or femoral vein (H) (Anaes.) (Assist.)
970.05
34809
Saphenous vein anastomosis to femoral or popliteal vein for femoral vein bypass (H) (Anaes.) (Assist.)
970.05
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.)
1 173.05
34815
Vein stenosis, patch angioplasty for, (excluding vein graft stenosis)—using vein or synthetic material (H) (Anaes.) (Assist.)
970.05
34818
Venous valve, plication or repair to restore valve competency (H) (Anaes.) (Assist.)
1 067.80
34821
Vein transplant to restore valvular function (Anaes.) (Assist.)
1 451.45
34824
External stent, application of, to restore venous valve competency to superficial vein—one stent (H) (Anaes.) (Assist.)
496.30
34827
External stents, application of, to restore venous valve competency to superficial vein or veins—more than one stent (H) (Anaes.) (Assist.)
601.65
34830
External stent, application of, to restore venous valve competency to deep vein—one stent (Anaes.) (Assist.)
707.00
34833
External stents, application of, to restore venous valve competency to deep vein or veins—more than one stent (H) (Anaes.) (Assist.)
917.40
35000
Lumbar sympathectomy (Anaes.) (Assist.)
707.00
35003
Cervical or upper thoracic sympathectomy by any surgical approach (H) (Anaes.) (Assist.)
917.40
35006
Cervical or upper thoracic sympathectomy, if operation is a re‑operation for previous incomplete sympathectomy by any surgical approach (H) (Anaes.) (Assist.)
1 150.55
35009
Lumbar sympathectomy, if operation is following chemical sympathectomy or for previous incomplete surgical sympathectomy (H) (Anaes.) (Assist.)
894.75
35012
Sacral or pre‑sacral sympathectomy (H) (Anaes.) (Assist.)
707.00
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.)
368.55
35103
Ischaemic limb, debridement of necrotic material, gangrenous tissue, or slough in, in the operating theatre of a hospital, superficial tissue only (Anaes.)
234.55
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.)
171.50
35202
Major arteries or veins in the neck, abdomen or extremities, access to, as part of re‑operation after prior surgery on these vessels (H) (Anaes.) (Assist.)
817.10
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 after‑care (Anaes.) (Assist.)
515.35
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 after‑care (Anaes.) (Assist.)
660.80
35306
Transluminal stent insertion 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 after‑care (Anaes.) (Assist.)
609.90
35307
Transluminal stent insertion, one or more stents (not drug‑eluting), 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 after‑care (H) (Anaes.) (Assist.)
1 121.15
35309
Transluminal stent insertion 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 after‑care (Anaes.) (Assist.)
762.35
35312
Peripheral arterial atherectomy including associated balloon dilatation of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding after‑care (H) (Anaes.) (Assist.)
864.05
35315
Peripheral laser angioplasty including associated balloon dilatation of one limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding after‑care (H) (Anaes.) (Assist.)
864.05
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 after‑care (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.)
355.80
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 after‑care (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.)
637.80
35320
Peripheral arterial or venous catheterisation with administration of thrombolytic or chemotherapeutic agents, by open exposure, excluding associated radiological services or preparation, and excluding after‑care (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.)
856.70
35321
Peripheral arterial or venous catheterisation to administer agents to occlude arteries, veins or arterio‑venous 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 after‑care (other than a service associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)
813.30
35324
Angioscopy not combined with another procedure, excluding associated radiological services or preparation, and excluding after‑care (H) (Anaes.) (Assist.)
304.95
35327
Angioscopy combined with another procedure, excluding associated radiological services or preparation, and excluding after‑care (H) (Anaes.) (Assist.)
408.70
35330
Insertion of inferior vena caval filter, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding after‑care (Anaes.) (Assist.)
515.35
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.)
592.45
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.)
828.20
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.)
710.30
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.)
592.45
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.)
474.65
35404
Dosimetry, handling and injection of sir‑spheres 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, payable once only (H) (Anaes.) (Assist.)
346.60
35406
Trans‑femoral catheterisation of the hepatic artery to administer sir‑spheres, 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.)
813.30
35408
Catheterisation of the hepatic artery via a permanently implanted hepatic artery port to administer sir‑spheres, 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.)
610.10
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.)
813.30
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 intra‑operative imaging, but in association with pre‑operative diagnostic imaging under item 60009, 60010, 60072, 60073, 60075, 60076, 60078 or 60079, including aftercare (Anaes.) (Assist.)
2 857.55
Subdivision D—Subgroups 4, 5 and 6 of Group T8
2.44.17 Application of items 38470 to 38766
Items 38470 to 38766 must be performed using open exposure or minimally invasive surgery which excludes percutaneous and transcatheter techniques unless otherwise stated in the item.
Group T8—Surgical operations
Item
Description
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.)
81.30
35502
Intra‑uterine 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.)
80.15
35503
Intra‑uterine 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 mentioned in item 30062) (Anaes.)
53.55
35506
Intra‑uterine contraceptive device, removal of under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)
53.70
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.)
174.45
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.)
256.95
35509
Hymenectomy (Anaes.)
89.45
35512
Bartholin’s cyst, excision of (G) (Anaes.)
179.40
35513
Bartholin’s cyst, excision of (S) (Anaes.)
221.70
35516
Bartholin’s cyst or gland, marsupialisation of (G) (Anaes.)
116.35
35517
Bartholin’s cyst or gland, marsupialisation of (S) (Anaes.)
146.00
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.)
207.85
35520
Bartholin’s abscess, incision of (Anaes.)
58.30
35523
Urethra or urethral caruncle, cauterisation of (Anaes.)
58.30
35526
Urethral caruncle, excision of (G) (Anaes.)
116.35
35527
Urethral caruncle, excision of (S) (Anaes.)
146.00
35530
Clitoris, amputation of, if medically indicated (H) (Anaes.) (Assist.)
269.85
35533
Vulvoplasty or labioplasty, for repair of:
(a) female genital mutilation; or
(b) anomalies associated with major congenital anomalies of the uro‑gynaecological tract
other than a service associated with a service to which item 35536, 37836, 37050, 37842, 37851 or 43882 applies (H) (Anaes.)
349.85
35534
Vulvoplasty or labioplasty, for localised gigantism if it can be demonstrated that:
(a) the structural abnormality is causing significant functional impairment; and
(b) non‑surgical treatments have failed
(H) (Anaes.)
349.85
35536
Vulva, wide local excision of suspected malignancy or hemivulvectomy, one or both procedures (Anaes.) (Assist.)
348.45
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.)
272.95
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.)
319.60
35545
Colposcopically directed CO2 laser therapy for condylomata, unsuccessfully treated by other methods (Anaes.)
183.60
35548
Vulvectomy, radical, for malignancy (H) (Anaes.) (Assist.)
834.05
35551
Pelvic lymph glands, excision of (radical) (H) (Anaes.) (Assist.)
683.90
35554
Vagina, dilatation of, as an independent procedure including any associated consultation (Anaes.)
43.50
35557
Vagina, removal of simple tumour—(including Gartner duct cyst) (Anaes.)
214.50
35560
Vagina, partial or complete removal of (H) (Anaes.) (Assist.)
683.90
35561
Vaginectomy, radical, for proven invasive malignancy—one surgeon (H) (Anaes.) (Assist.)
1 379.50
35562
Vaginectomy, radical, for proven invasive malignancy, conjoint surgery—abdominal surgeon (including after‑care) (H) (Anaes.) (Assist.)
1 132.60
35564
Vaginectomy, radical, for proven invasive malignancy, conjoint surgery—perineal surgeon (H) (Assist.)
522.85
35565
Vaginal reconstruction for congenital absence, gynatresia or urogenital sinus (H) (Anaes.) (Assist.)
683.90
35566
Vaginal septum, excision of, for correction of double vagina (H) (Anaes.) (Assist.)
397.25
35568
Sacrospinous colpopexy for the management of upper vaginal prolapse (H) (Anaes.) (Assist.)
624.60
35569
Plastic repair to enlarge vaginal orifice (H) (Anaes.)
160.85
35570
Anterior vaginal compartment repair by vaginal approach (involving repair of urethrocele and cystocele), with or without mesh, other than a service associated with a service to which item 35573, 35577 or 35578 applies (H) (Anaes.) (Assist.)
553.85
35571
Posterior vaginal compartment repair by vaginal approach involving repair of one or more of the following:
(a) perineum;
(b) rectocoele;
(c) enterocoele;
with or without mesh, other than a service associated with a service to which item 35573, 35577 or 35578 applies (H) (Anaes.) (Assist.)
553.85
35572
Colpotomy, other than a service to which another item in this Group applies (H) (Anaes.)
123.80
35573
Anterior and posterior vaginal compartment repair by vaginal approach (involving anterior and posterior compartment defects), with or without mesh, other than a service associated with a service to which item 35577 or 35578 applies (H) (Anaes.) (Assist.)
830.90
35577
Manchester (Donald Fothergill) operation for genital prolapse, with or without mesh (H) (Anaes.) (Assist.)
674.50
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.)
674.50
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.)
1 155.00
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.)
683.90
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.)
1 473.20
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.)
674.50
35602
Stress incontinence, combined synchronous abdomino‑vaginal operation for—abdominal procedure, with or without mesh, (including after‑care), other than a service associated with a service to which item 30405 applies (H) (Anaes.) (Assist.)
674.50
35605
Stress incontinence, combined synchronous abdomino‑vaginal operation for—vaginal procedure, with or without mesh, (including after‑care), other than a service associated with a service to which item 30405 applies (Anaes.) (Assist.)
365.95
35608
Cervix, cauterisation (other than by chemical means), ionisation, diathermy or biopsy of, with or without dilatation of cervix (Anaes.)
64.00
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.)
64.00
35612
Cervix, residual stump, removal of, by abdominal approach (Anaes.) (Assist.)
506.00
35613
Cervix, residual stump, removal of, by vaginal approach (H) (Anaes.) (Assist.)
404.80
35614
Examination of lower genital tract by a Hinselmann‑type colposcope in a patient with a previous abnormal cervical smear 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.)
63.90
35615
Vulva, biopsy of, when performed in conjunction with a service to which item 35614 applies
53.70
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.)
449.60
35617
Cervix, cone biopsy, amputation or repair of, other than a service to which item 35577 or 35578 applies (G) (Anaes.)
173.70
35618
Cervix, cone biopsy, amputation or repair of, other than a service to which item 35577 or 35578 applies (S) (Anaes.)
218.00
35620
Endometrial biopsy if malignancy is suspected in patients with abnormal uterine bleeding or post‑menopausal bleeding (Anaes.)
53.35
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.)
602.45
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.)
819.25
35626
Hysteroscopy, including biopsy, performed by a specialist in the practice of his or her specialty, if the patient is referred to him or her 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
82.80
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.)
107.15
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 (Anaes.)
183.00
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.)
218.00
35634
Hysteroscopic resection of uterine septum followed by endometrial ablation by laser or diathermy (Anaes.)
685.70
35635
Hysteroscopy involving resection of the uterine septum (H) (Anaes.)
299.45
35636
Hysteroscopy, involving resection of myoma, or resection of myoma and uterine septum (if both are performed) (H) (Anaes.)
433.00
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.)
406.65
35638
Complicated operative laparoscopy, including use of laser when required, for one or more of the following procedures—oophorectomy, ovarian cystectomy, myomectomy, salpingectomy or salpingostomy, ablation of moderate or severe endometriosis requiring more than 1 hour’s operating time, or division of utero‑sacral ligaments for significant dysmenorrhoea—other than a service associated with another intraperitoneal or retroperitoneal procedure except item 30393 (H) (Anaes.) (Assist.)
711.50
35639
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 (G) (H) (Anaes.)
134.90
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 (S) (H) (Anaes.)
183.00
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.)
1 242.65
35643
Evacuation of the contents of the gravid uterus by curettage or suction curettage other than a service to which item 35639 or 35640 applies, including procedures to which item 35626, 35627 or 35630 applies, if performed (Anaes.)
218.00
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 35639, 35640 or 35647 applies (Anaes.)
203.65
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.)
318.70
35646
Cervix, colposcopy with radical diathermy of, with or without cervical biopsy, for previously confirmed intraepithelial neoplastic changes of the cervix, if performed in the operating theatre of a hospital (Anaes.)
203.65
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.)
203.65
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.)
318.70
35649
Hysterotomy or uterine myomectomy, abdominal (H) (Anaes.) (Assist.)
536.00
35653
Hysterectomy, abdominal, sub‑total or total, with or without removal of uterine adnexae (H) (Anaes.) (Assist.)
674.70
35657
Hysterectomy, vaginal, with or without uterine curettage, other than a service to which item 35673 applies (H) (Anaes.) (Assist.)
674.70
35658
Uterus (at least equivalent in size to a 10 week gravid uterus), debulking of, before vaginal removal at hysterectomy (H) (Anaes.) (Assist.)
416.05
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.)
871.30
35664
Radical hysterectomy with radical excision of pelvic lymph glands (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.)
1 452.20
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.)
1 234.25
35670
Hysterectomy, abdominal, with radical excision of pelvic lymph glands, with or without removal of uterine adnexae (H) (Anaes.) (Assist.)
1 016.30
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.)
757.80
35674
Ultrasound guided needling and injection of ectopic pregnancy
207.85
35676
Ectopic pregnancy, removal of (G) (H) (Anaes.) (Assist.)
425.00
35677
Ectopic pregnancy, removal of (S) (H) (Anaes.) (Assist.)
536.00
35678
Ectopic pregnancy, laparoscopic removal of (H) (Anaes.) (Assist.)
646.25
35680
Bicornuate uterus, plastic reconstruction for (Anaes.) (Assist.)
582.05
35683
Uterus, suspension or fixation of, as an independent procedure (G) (H) (Anaes.) (Assist.)
351.30
35684
Uterus, suspension or fixation of, as an independent procedure (S) (H) (Anaes.) (Assist.)
471.15
35687
Sterilisation by transection or resection of fallopian tubes, via abdominal or vaginal routes or via laparoscopy using diathermy or another method (G) (H) (Anaes.) (Assist.)
325.20
35688
Sterilisation by transection or resection of fallopian tubes, via abdominal or vaginal routes or via laparoscopy using diathermy or another method (S) (H) (Anaes.) (Assist.)
397.25
35691
Sterilisation by interruption of fallopian tubes when performed in conjunction with Caesarean section (H) (Anaes.) (Assist.)
158.70
35694
Tuboplasty (salpingostomy, salpingolysis or tubal implantation into uterus), unilateral or bilateral, one or more procedures (H) (Anaes.) (Assist.)
637.70
35697
Microsurgical tuboplasty (salpingostomy, salpingolysis or tubal implantation into uterus), unilateral or bilateral, one or more procedures (H) (Anaes.) (Assist.)
946.20
35700
Fallopian tubes, unilateral microsurgical anastomosis of, using operating microscope (H) (Anaes.) (Assist.)
730.05
35703
Hydrotubation of fallopian tubes as a non‑repetitive procedure, other than a service associated with a service to which another item in this Subgroup applies (Anaes.)
67.50
35706
Rubin test for patency of fallopian tubes (Anaes.)
67.50
35709
Fallopian tubes, hydrotubation of, as a repetitive post‑operative procedure (Anaes.)
43.50
35710
Falloposcopy, unilateral or bilateral, including hysteroscopy and tubal catheterisation (H) (Anaes.) (Assist.)
463.30
35712
Laparotomy, involving oophorectomy, salpingectomy, salpingo‑oophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—one such procedure, other than a service associated with hysterectomy (G) (H) (Anaes.) (Assist.)
362.15
35713
Laparotomy, involving oophorectomy, salpingectomy, salpingo‑oophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—one such procedure, other than a service associated with hysterectomy (S) (H) (Anaes.) (Assist.)
452.85
35716
Laparotomy, involving oophorectomy, salpingectomy, salpingo‑oophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—2 or more such procedures, unilateral or bilateral, other than a service associated with hysterectomy (G) (H) (Anaes.) (Assist.)
434.35
35717
Laparotomy, involving oophorectomy, salpingectomy, salpingo‑oophorectomy, removal of ovarian, parovarian, fimbrial or broad ligament cyst—2 or more such procedures, unilateral or bilateral, other than a service associated with hysterectomy (S) (H) (Anaes.) (Assist.)
545.30
35720
Radical or debulking operation for advanced gynaecological malignancy, with or without omentectomy (H) (Anaes.) (Assist.)
674.50
35723
Retro‑peritoneal lymph node biopsies from above the level of the aortic bifurcation, for staging or restaging of gynaecological malignancy (H) (Anaes.) (Assist.)
483.10
35726
Infra‑colic omentectomy with multiple peritoneal biopsies for staging or restaging of gynaecological malignancy (H) (Anaes.) (Assist.)
483.10
35729
Ovarian transposition out of the pelvis, in conjunction with radical hysterectomy for invasive malignancy (H) (Anaes.)
217.80
35750
Laparoscopically assisted hysterectomy, including any associated laparoscopy (H) (Anaes.) (Assist.)
784.60
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.)
867.60
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.)
1 091.90
35756
Laparoscopically assisted hysterectomy, when procedure is completed by open hysterectomy, including any associated laparoscopy (H) (Anaes.) (Assist.)
784.60
35759
Procedure for the control of post‑operative haemorrhage following gynaecological surgery, under general anaesthesia, utilising a vaginal or abdominal and vaginal approach if no other procedure is performed (H) (Anaes.) (Assist.)
563.30
Subgroup 5—Urological
36500
Adrenal gland, excision of—partial or total (H) (Anaes.) (Assist.)
924.70
36502
Pelvic lymphadenectomy, open or laparoscopic, or both, unilateral or bilateral (H) (Anaes.) (Assist.)
683.90
36503
Renal transplant, other than a service to which item 36506 or 36509 applies (H) (Anaes.) (Assist.)
1 391.15
36506
Renal transplant, performed by vascular surgeon and urologist operating together—vascular anastomosis, including after‑care (H) (Anaes.) (Assist.)
924.70
36509
Renal transplant, performed by vascular surgeon and urologist operating together—ureterovesical anastomosis, including after‑care (H) (Assist.)
782.95
36516
Nephrectomy, complete (H) (Anaes.) (Assist.)
924.70
36519
Nephrectomy, complete, complicated by previous surgery on the same kidney (H) (Anaes.) (Assist.)
1 291.10
36522
Nephrectomy, partial (H) (Anaes.) (Assist.)
1 107.95
36525
Nephrectomy, partial, complicated by previous surgery on the same kidney (H) (Anaes.) (Assist.)
1 574.45
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.)
1 291.10
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.)
1 593.40
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.)
1 291.10
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.)
1 593.40
36531
Nephro‑ureterectomy, complete, including associated bladder repair and any associated endoscopic procedure (H) (Anaes.) (Assist.)
1 157.85
36532
Nephro‑ureterectomy, for tumour, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures (H) (Anaes.) (Assist.)
1 661.85
36533
Nephro‑ureterectomy, 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.)
1 964.15
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.)
691.40
36540
Nephrolithotomy or pyelolithotomy, or both, through the same skin incision, for one or 2 stones (Anaes.) (Assist.)
1 107.95
36543
Nephrolithotomy or pyelolithotomy, or both, extended, for staghorn stone or 3 or more stones, including one or more of the following: nephrostomy, pyelostomy, pedicle control with or without freezing, calyorrhaphy or pyeloplasty (Anaes.) (Assist.)
1 291.10
36546
Extracorporeal shock wave lithotripsy (ESWL) to urinary tract and post‑treatment care for 3 days, including pre‑treatment consultations, unilateral (Anaes.)
691.40
36549
Ureterolithotomy (H) (Anaes.) (Assist.)
833.10
36552
Nephrostomy or pyelostomy, open, as an independent procedure (H) (Anaes.) (Assist.)
741.50
36558
Renal cyst or cysts, excision or unroofing of (Anaes.) (Assist.)
649.80
36561
Renal biopsy (closed) (Anaes.)
172.50
36564
Pyeloplasty (plastic reconstruction of the pelvi‑ureteric junction), by open exposure, laparoscopy or laparoscopic assisted techniques (H) (Anaes.) (Assist.)
924.70
36567
Pyeloplasty in a kidney that is congenitally abnormal in addition to the presence of pelvic‑ureteric junction obstruction, or in a solitary kidney, by open exposure (H) (Anaes.) (Assist.)
1 016.30
36570
Pyeloplasty, complicated by previous surgery on the same kidney, by open exposure (H) (Anaes.) (Assist.)
1 291.10
36573
Divided ureter, repair of (H) (Anaes.) (Assist.)
924.70
36576
Kidney, exposure and exploration of, including repair or nephrectomy, for trauma, other than a service associated with another procedure performed on the kidney, renal pelvis or renal pedicle (H) (Anaes.) (Assist.)
1 157.85
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.)
741.50
36585
Ureter, transplantation of, into skin (H) (Anaes.) (Assist.)
741.50
36588
Ureter, reimplantation into bladder (H) (Anaes.) (Assist.)
924.70
36591
Ureter, reimplantation into bladder with psoas hitch or Boari flap or both (H) (Anaes.) (Assist.)
1 107.95
36594
Ureter, transplantation of, into intestine (H) (Anaes.) (Assist.)
924.70
36597
Ureter, transplantation of, into another ureter (H) (Anaes.) (Assist.)
924.70
36600
Ureter, transplantation of, into isolated intestinal segment, unilateral (Anaes.) (Assist.)
1 107.95
36603
Ureters, transplantation of, into isolated intestinal segment, bilateral (H) (Anaes.) (Assist.)
1 291.10
36604
Ureteric stent, passage of through percutaneous nephrostomy tube, using interventional imaging techniques (Anaes.)
267.65
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.)
690.70
36606
Intestinal urinary reservoir, continent, formation of, including formation of non‑return valves and implantation of ureters (one or both) into reservoir (H) (Anaes.) (Assist.)
2 315.80
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.)
690.70
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.)
267.65
36609
Intestinal urinary conduit or ureterostomy, revision of (H) (Anaes.) (Assist.)
741.50
36612
Ureter, exploration of, with or without drainage of, as an independent procedure (H) (Anaes.) (Assist.)
649.80
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.)
741.50
36618
Reduction ureteroplasty (H) (Anaes.) (Assist.)
649.80
36621
Closure of cutaneous ureterostomy (H) (Anaes.) (Assist.)
464.50
36624
Nephrostomy, percutaneous, using interventional imaging techniques (Anaes.) (Assist.)
558.10
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.)
691.40
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.)
341.50
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.)
741.50
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.)
399.90
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.)
833.10
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.)
416.45
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.)
1 066.30
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.)
949.60
36649
Nephrostomy drainage tube, exchange of—but not including imaging (Anaes.) (Assist.)
267.65
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.)
149.70
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.)
649.80
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.)
833.10
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.)
1 066.30
36658
Sacral nerve stimulation for refractory urinary incontinence or urge retention, removal of pulse generator and leads
526.40
36660
Sacral nerve stimulation for refractory urinary incontinence or urge retention, removal and replacement of pulse generator
255.45
36662
Sacral nerve stimulation for refractory urinary incontinence or urge retention, removal and replacement of leads
610.30
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) intra‑operative test stimulation, to manage:
(i) detrusor over‑activity that has been refractory to at least 12 months conservative non‑surgical treatment; or
(ii) non‑obstructive urinary retention that has been refractory to at least 12 months conservative non‑surgical treatment;
in a patient who is at least 18 years old (Anaes.)
660.95
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) intra‑operative test stimulation, to correct displacement or unsatisfactory positioning, if inserted for the management of:
(i) detrusor over‑activity that has been refractory to at least 12 months conservative non‑surgical treatment; or
(ii) non‑obstructive urinary retention that has been refractory to at least 12 months conservative non‑surgical treatment;
in a patient who is at least 18 years old—other than a service to which item 36663 applies (Anaes.)
593.55
36665
Sacral nerve electrode or electrodes, management and adjustment of the pulse generator by a medical practitioner, to manage detrusor over‑activity or non‑obstructive urinary retention—each day
125.40
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 over‑activity that has been refractory to at least 12 months conservative non‑surgical treatment; or
(b) non‑obstructive urinary retention that has been refractory to at least 12 months conservative non‑surgical treatment;
in a patient who is at least 18 years old (Anaes.)
334.00
36667
Sacral nerve lead or leads, removal of, if the lead was inserted to manage:
(a) detrusor over‑activity that has been refractory to at least 12 months conservative non‑surgical treatment; or
(b) non‑obstructive urinary retention that has been refractory to at least 12 months conservative non‑surgical treatment;
in a patient who is at least 18 years old (Anaes.)
156.30
36668
Pulse generator, removal of, if the pulse generator was inserted to manage:
(a) detrusor over‑activity that has been refractory to at least 12 months conservative non‑surgical treatment; or
(b) non‑obstructive urinary retention that has been refractory to at least 12 months conservative non‑surgical treatment;
in a patient who is at least 18 years old (Anaes.)
156.30
36800
Bladder, catheterisation of, if no other procedure is performed (Anaes.)
27.60
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.)
466.35
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.)
649.80
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.)
833.10
36811
Cystoscopy with insertion of urethral prosthesis (Anaes.)
323.40
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.)
166.70
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.)
237.90
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.)
276.60
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.)
323.20
36824
Cystoscopy with ureteric catheterisation, unilateral or bilateral, other than a service associated with a service to which item 36818 or 36821 applies (Anaes.)
213.15
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.)
581.30
36827
Cystoscopy, with controlled hydro‑dilatation of the bladder (Anaes.)
229.85
36830
Cystoscopy, with ureteric meatotomy (H) (Anaes.)
203.25
36833
Cystoscopy with removal of ureteric stent or other foreign body (Anaes.) (Assist.)
276.60
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.)
229.85
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.)
323.20
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.)
325.20
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.)
691.40
36848
Cystoscopy with resection of ureterocele (H) (Anaes.)
229.85
36851
Cystoscopy with injection into bladder wall, other than a service associated with a service to which item 18375 or 18379 applies (H) (Anaes.)
229.85
36854
Cystoscopy with endoscopic incision or resection of external sphincter, bladder neck or both (H) (Anaes.)
466.35
36857
Endoscopic manipulation or extraction of ureteric calculus (H) (Anaes.)
366.45
36860
Endoscopic examination of intestinal conduit or reservoir (Anaes.)
166.70
36863
Litholapaxy, with or without cystoscopy (H) (Anaes.) (Assist.)
466.35
37000
Bladder, partial excision of (H) (Anaes.) (Assist.)
741.50
37004
Bladder, repair of rupture (H) (Anaes.) (Assist.)
649.80
37008
Cystostomy or cystotomy, suprapubic, other than a service to which item 37011 applies or a service associated with other open bladder procedure (Anaes.)
416.45
37011
Suprapubic stab cystotomy, other than a service associated with a service to which items 37200 to 37221 apply (Anaes.)
93.35
37014
Bladder, total excision of (H) (Anaes.) (Assist.)
1 066.30
37020
Bladder diverticulum, excision or obliteration of (H) (Anaes.) (Assist.)
741.50
37023
Vesical fistula, cutaneous, operation for (H) (Anaes.)
416.45
37026
Cutaneous vesicostomy, establishment of (H) (Anaes.) (Assist.)
416.45
37029
Vesico‑vaginal fistula, closure of, by abdominal approach (H) (Anaes.) (Assist.)
924.70
37038
Vesico‑intestinal fistula, closure of, excluding bowel resection (H) (Anaes.) (Assist.)
691.75
37041
Bladder aspiration, by needle
46.60
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.)
911.30
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.)
674.50
37044
Bladder stress incontinence, suprapubic procedure for, eg Burch colposuspension, with or without mesh, other than a service associated with a service to which item 30405 or 35599 applies (H) (Anaes.) (Assist.)
691.75
37045
Mitrofanoff continent valve, formation of (H) (Anaes.) (Assist.)
1 428.75
37047
Bladder enlargement using intestine (H) (Anaes.) (Assist.)
1 666.05
37050
Bladder exstrophy closure, not involving sphincter reconstruction (H) (Anaes.) (Assist.)
741.50
37053
Bladder transection and re‑anastomosis to trigone (H) (Anaes.) (Assist.)
856.70
37200
Prostatectomy, open (H) (Anaes.) (Assist.)
1 016.30
37201
Prostate, transurethral radio‑frequency 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.)
828.85
37202
Prostate, transurethral radio‑frequency 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.)
416.05
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.)
1 042.15
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.)
558.10
37207
Prostate, endoscopic non‑contact (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.)
866.45
37208
Prostate, endoscopic non‑contact (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.)
416.05
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.)
1 291.10
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.)
1 593.40
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.)
1 935.20
37212
Prostate, open perineal biopsy or open drainage of abscess (H) (Anaes.) (Assist.)
276.60
37215
Prostate, biopsy of, endoscopic, with or without cystoscopy (Anaes.) (Assist.)
416.45
37217
Prostate, implantation of radio‑opaque fiducial markers into the prostate gland or prostate surgical bed (Anaes.)
138.30
37218
Prostate, needle biopsy of, or injection into, excluding insertion of radioopaque markers (Anaes.)
138.30
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.)
280.85
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.)
1 044.20
37221
Prostatic abscess, endoscopic drainage of (H) (Anaes.) (Assist.)
466.35
37223
Prostatic coil, insertion of, under ultrasound control (H) (Anaes.)
206.25
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.)
323.20
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
565.85
37230
Prostate, high‑energy 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.)
1 042.15
37233
Prostate, high‑energy 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.)
558.10
37245
Prostate, endoscopic enucleation of, using high powered Holmium:YAG laser and an end firing, non‑contact 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.)
1 262.15
37300
Urethral sounds, passage of, as an independent procedure (Anaes.)
46.60
37303
Urethral stricture, dilatation of (Anaes.)
74.05
37306
Urethra, repair of rupture of distal section (H) (Anaes.) (Assist.)
649.80
37309
Urethra, repair of rupture of prostatic or membranous segment (H) (Anaes.) (Assist.)
924.70
37315
Urethroscopy, as an independent procedure (Anaes.)
138.30
37318
Urethroscopy, with any one or more of biopsy, diathermy, visual laser destruction of stone or removal of foreign body or stone (Anaes.) (Assist.)
276.60
37321
Urethral meatotomy, external (Anaes.)
93.35
37324
Urethrotomy or urethrostomy, internal or external (H) (Anaes.)
229.85
37327
Urethrotomy, optical, for urethral stricture (H) (Anaes.) (Assist.)
323.20
37330
Urethrectomy, partial or complete, for removal of tumour (H) (Anaes.) (Assist.)
649.80
37333
Urethro‑vaginal fistula, closure of (H) (Anaes.) (Assist.)
558.10
37336
Urethro‑rectal fistula, closure of (H) (Anaes.) (Assist.)
741.50
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.)
239.85
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.)
425.00
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.)
911.30
37342
Urethroplasty—single stage operation (H) (Anaes.) (Assist.)
833.10
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 re‑routing of the urethra around the crura (H) (Anaes.) (Assist.)
1 391.15
37345
Urethroplasty—2 stage operation—first stage (H) (Anaes.) (Assist.)
691.40
37348
Urethroplasty—2 stage operation—second stage (H) (Anaes.) (Assist.)
691.40
37351
Urethroplasty, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
276.60
37354
Hypospadias, meatotomy and hemi‑circumcision (H) (Anaes.) (Assist.)
323.20
37369
Urethra, excision of prolapse of (H) (Anaes.)
186.60
37372
Urethral diverticulum, excision of (H) (Anaes.) (Assist.)
466.35
37375
Urethral sphincter, reconstruction by bladder tubularisation technique or similar procedure (H) (Anaes.) (Assist.)
1 157.85
37381
Artificial urinary sphincter, insertion of cuff, perineal approach (H) (Anaes.) (Assist.)
741.50
37384
Artificial urinary sphincter, insertion of cuff, abdominal approach (H) (Anaes.) (Assist.)
1 157.85
37387
Artificial urinary sphincter, insertion of pressure regulating balloon and pump (H) (Anaes.) (Assist.)
323.20
37390
Artificial urinary sphincter, revision or removal of, with or without replacement (H) (Anaes.) (Assist.)
924.70
37393
Priapism, decompression by glanular stab caverno‑sospongiosum shunt or penile aspiration with or without lavage (Anaes.)
229.85
37396
Priapism, shunt operation for, other than a service to which item 37393 applies (H) (Anaes.) (Assist.)
741.50
37402
Penis, partial amputation of (H) (Anaes.) (Assist.)
466.35
37405
Penis, complete or radical amputation of (H) (Anaes.) (Assist.)
924.70
37408
Penis, repair of laceration of cavernous tissue, or fracture involving cavernous tissue (H) (Anaes.) (Assist.)
466.35
37411
Penis, repair of avulsion (Anaes.) (Assist.)
924.70
37415
Penis, injection of, for the investigation and treatment of impotence—2 services only in a period of 36 consecutive months
46.60
37417
Penis, correction of chordee, with or without excision of fibrous plaque or plaques and with or without grafting (H) (Anaes.) (Assist.)
558.10
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.)
741.50
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.)
366.45
37423
Penis, lengthening by translocation of corpora (H) (Anaes.) (Assist.)
924.70
37426
Penis, artificial erection device, insertion of, into one or both corpora (H) (Anaes.) (Assist.)
974.55
37429
Penis, artificial erection device, insertion of pump and pressure regulating reservoir (H) (Anaes.) (Assist.)
323.20
37432
Penis, artificial erection device, complete or partial revision or removal of components, with or without replacement (H) (Anaes.) (Assist.)
924.70
37435
Penis, frenuloplasty as an independent procedure (Anaes.)
93.35
37438
Scrotum, partial excision of (Anaes.) (Assist.)
276.60
37444
Ureterolithotomy complicated by previous surgery at the same site of the same ureter (Anaes.) (Assist.)
999.65
37601
Spermatocele or epididymal cyst, excision of, one or more of, on one side (Anaes.)
276.60
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.)
276.60
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.)
373.45
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.)
554.55
37607
Retroperitoneal lymph node dissection, unilateral, other than a service associated with a service to which item 36528 applies (H) (Anaes.) (Assist.)
924.70
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.)
1 391.15
37613
Epididymectomy (Anaes.)
276.60
37616
Vasovasostomy or vasoepididymostomy, unilateral, using the operating microscope, other than a service associated with sperm harvesting for IVF (H) (Anaes.) (Assist.)
691.40
37619
Vasovasostomy or vasoepididymostomy, unilateral, other than a service associated with sperm harvesting for IVF (Anaes.) (Assist.)
276.60
37622
Vasotomy or vasectomy, unilateral or bilateral (G) (Anaes.)
193.20
37623
Vasotomy or vasectomy, unilateral or bilateral (S) (Anaes.)
229.85
37800
Patent urachus, excision of (H) (Anaes.) (Assist.)
521.25
37803
Undescended testis, orchidopexy for, other than a service to which item 37806 applies (H) (Anaes.) (Assist.)
521.25
37806
Undescended testis in inguinal canal close to deep inguinal ring or within abdominal cavity, orchidopexy for (Anaes.) (Assist.)
602.25
37809
Undescended testis, revision orchidopexy for (H) (Anaes.) (Assist.)
602.25
37812
Impalpable testis, exploration of groin for, other than a service associated with a service to which items 37803 to 37809 apply (H) (Anaes.) (Assist.)
556.00
37815
Hypospadias, examination under anaesthesia with erection test (H) (Anaes.)
92.75
37818
Hypospadias, glanuloplasty incorporating meatal advancement (Anaes.) (Assist.)
491.45
37821
Hypospadias, distal, one stage repair (H) (Anaes.) (Assist.)
833.10
37824
Hypospadias, proximal, one stage repair (H) (Anaes.) (Assist.)
1 158.30
37827
Hypospadias, staged repair, first stage (H) (Anaes.) (Assist.)
533.60
37830
Hypospadias, staged repair, second stage (Anaes.) (Assist.)
691.40
37833
Hypospadias, repair of post‑operative urethral fistula (H) (Anaes.) (Assist.)
329.95
37836
Epispadias, staged repair, first stage (H) (Anaes.) (Assist.)
695.00
37839
Epispadias, staged repair, second stage (H) (Anaes.) (Assist.)
787.60
37842
Exstrophy of bladder or epispadias, secondary repair with bladder neck tightening, with or without ureteric reimplantation (H) (Anaes.) (Assist.)
1 529.10
37845
Ambiguous genitalia with urogenital sinus, reduction clitoroplasty, with or without endoscopy (H) (Anaes.) (Assist.)
695.00
37848
Ambiguous genitalia with urogenital sinus, reduction clitoroplasty, with endoscopy and vaginoplasty (H) (Anaes.) (Assist.)
1 251.05
37851
Congenital adrenal hyperplasia, mixed gonadal dysgenesis or similar condition, vaginoplasty for, with or without endoscopy (H) (Anaes.) (Assist.)
926.80
37854
Urethral valve, destruction of, including cystoscopy and urethroscopy (H) (Anaes.) (Assist.)
366.45
Subgroup 6—Cardio‑Thoracic
38200
Right heart catheterisation with any one or more of—fluoroscopy, oximetry, dye dilution curves, cardiac output measurement by any method, shunt detection or exercise stress test (Anaes.)
445.40
38203
Left heart catheterisation by percutaneous arterial puncture, arteriotomy or percutaneous left ventricular puncture with any one or more of—fluoroscopy, oximetry, dye dilution curves, cardiac output measurements by any method, shunt detection or exercise stress test (Anaes.)
531.55
38206
Right heart catheterisation with left heart catheterisation via the right heart or by another procedure, with any one or more of—fluoroscopy, oximetry, dye dilution curves, cardiac output measurements by any method, shunt detection or exercise stress test (Anaes.)
642.65
38209
Cardiac electrophysiological study—up to and including 3 catheter investigation of any one or more of—syncope, atrio‑ventricular 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.)
825.15
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 anti‑arrhythmic drug testing with pre and post drug inductions; or
(e) catheter ablation to intentionally induce complete AV block; or
(f) intra‑operative 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.)
1 372.45
38213
Cardiac electrophysiological study, for follow‑up testing of implanted defibrillator—other than a service associated with a service to which item 38209 or 38212 applies (Anaes.)
408.70
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.)
354.90
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.)
532.25
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.)
177.40
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.)
354.90
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.)
532.35
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.)
709.90
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.)
887.25
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.)
709.75
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.)
887.20
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.)
1 064.60
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.)
469.70
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.)
443.60
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.)
887.20
38256
Temporary transvenous pacemaking electrode, insertion of (Anaes.)
267.25
38270
Balloon valvuloplasty or isolated atrial septostomy, including cardiac catheterisations before and after balloon dilatation (Anaes.) (Assist.)
912.30
38272
Atrial septal defect, closure using a septal occluder or similar device by transcatheter approach (Anaes.) (Assist.)
912.30
38273
Patent ductus arteriosus, transcatheter closure of, including cardiac catheterisation and any imaging associated with the service (H) (Anaes.) (Assist.)
912.30
38274
Ventricular septal defect, transcatheter closure of, with imaging and cardiac catheterisation (H) (Anaes.) (Assist.)
912.30
38275
Myocardial biopsy, by cardiac catheterisation (Anaes.)
298.20
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.)
192.90
38286
Implantable ECG loop recorder, removal of (H) (Anaes.)
173.75
38287
Ablation of arrhythmia circuit or focus or isolation procedure involving one atrial chamber (Anaes.) (Assist.)
2 098.45
38290
Ablation of arrhythmia circuits or foci, or isolation procedure involving both atrial chambers and including curative procedures for atrial fibrillation (H) (Anaes.) (Assist.)
2 671.95
38293
Ventricular arrhythmia with mapping and ablation, including all associated electrophysiological studies performed on the same day (Anaes.) (Assist.)
2 868.05
38300
Transluminal balloon angioplasty of one coronary artery, percutaneous or by open exposure, excluding associated radiological services, radiological preparation and after‑care (Anaes.) (Assist.)
515.35
38303
Transluminal balloon angioplasty of more than one coronary artery, percutaneous or by open exposure, excluding associated radiological services, radiological preparation and after‑care (Anaes.) (Assist.)
660.80
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 after‑care (Anaes.) (Assist.)
762.35
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 after‑care (Anaes.) (Assist.)
885.45
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 after‑care (H) (Anaes.) (Assist.)
1 132.35
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 after‑care (H) (Anaes.) (Assist.)
1 215.85
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 after‑care (H) (Anaes.) (Assist.)
1 586.35
38350
Single chamber permanent transvenous electrode (including cardiac electrophysiological services if used for pacemaker implantation), insertion, removal or replacement of (Anaes.)
638.65
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.)
255.45
38356
Dual chamber permanent transvenous electrodes (including cardiac electrophysiological services if used for pacemaker implantation), insertion, removal or replacement of (H) (Anaes.)
837.35
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.)
2 868.05
38359
Pericardium, paracentesis of (excluding after‑care) (Anaes.)
133.55
38362
Intra‑aortic balloon pump, percutaneous insertion of (H) (Anaes.)
384.95
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.)
255.45
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.)
1 224.60
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.)
287.85
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.)
1 052.65
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.)
287.85
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.)
1 052.65
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.)
287.85
38415
Empyema, radical operation for, involving resection of rib (Anaes.) (Assist.)
399.35
38418
Thoracotomy, exploratory, with or without biopsy (H) (Anaes.) (Assist.)
958.40
38421
Thoracotomy, with pulmonary decortication (H) (Anaes.) (Assist.)
1 532.00
38424
Thoracotomy, with pleurectomy or pleurodesis, or enucleation of hydatid cysts (H) (Anaes.) (Assist.)
958.40
38427
Thoracoplasty (complete)—3 or more ribs (H) (Anaes.) (Assist.)
1 183.40
38430
Thoracoplasty (in stages)—each stage (H) (Anaes.) (Assist.)
609.90
38436
Thoracoscopy, with or without division of pleural adhesions, including insertion of intercostal catheter, if necessary, with or without biopsy (H) (Anaes.)
249.75
38438
Pneumonectomy or lobectomy or segmentectomy other than a service associated with a service to which item 38418 applies (H) (Anaes.) (Assist.)
1 532.00
38440
Lung, wedge resection of (H) (Anaes.) (Assist.)
1 147.20
38441
Radical lobectomy or pneumonectomy including resection of chest wall, diaphragm, pericardium, or formal mediastinal node dissection (H) (Anaes.) (Assist.)
1 815.20
38446
Thoracotomy or sternotomy, for removal of thymus or mediastinal tumour (H) (Anaes.) (Assist.)
1 183.40
38447
Pericardiectomy via sternotomy or anterolateral thoracotomy without cardiopulmonary bypass (H) (Anaes.) (Assist.)
1 532.00
38448
Mediastinum, cervical exploration of, with or without biopsy (H) (Anaes.) (Assist.)
363.05
38449
Pericardiectomy via sternotomy or anterolateral thoracotomy with cardiopulmonary bypass (H) (Anaes.) (Assist.)
2 143.20
38450
Pericardium, transthoracic open surgical drainage of (H) (Anaes.) (Assist.)
856.65
38452
Pericardium, sub‑xyphoid open surgical drainage of (H) (Anaes.) (Assist.)
573.70
38453
Tracheal excision and repair without cardiopulmonary bypass (H) (Anaes.) (Assist.)
1 720.90
38455
Tracheal excision and repair of, with cardiopulmonary bypass (H) (Anaes.) (Assist.)
2 327.70
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.)
1 532.00
38457
Pectus excavatum or pectus carinatum, repair or radical correction of (H) (Anaes.) (Assist.)
1 430.25
38458
Pectus excavatum, repair of, with implantation of subcutaneous prosthesis (H) (Anaes.) (Assist.)
762.35
38460
Sternal wires or wires, removal of (H) (Anaes.)
275.40
38462
Sternotomy wound, debridement of, not involving reopening of the mediastinum (H) (Anaes.)
326.45
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.)
354.80
38466
Sternum, re‑operation on, for dehiscence or infection involving reopening of the mediastinum, with or without rewiring (H) (Anaes.) (Assist.)
958.00
38468
Sternum and mediastinum, re‑operation for infection of, involving muscle advancement flaps or greater omentum (H) (Anaes.) (Assist.)
1 476.15
38469
Sternum and mediastinum, re‑operation for infection of, involving muscle advancement flaps and greater omentum (H) (Anaes.) (Assist.)
1 720.90
38470
Permanent myocardial electrode, insertion of, by thoracotomy or sternotomy (H) (Anaes.) (Assist.)
958.40
38473
Permanent pacemaker electrode, insertion by open surgical approach (H) (Anaes.) (Assist.)
573.70
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.)
831.75
38477
Valve annuloplasty with insertion of ring other than a service to which item 38478 applies (H) (Anaes.) (Assist.)
2 003.35
38478
Valve annuloplasty with insertion of ring performed in conjunction with item 38480 or 38481 (H) (Anaes.) (Assist.)
970.40
38480
Valve repair, one leaflet (H) (Anaes.) (Assist.)
2 003.35
38481
Valve repair, 2 or more leaflets (H) (Anaes.) (Assist.)
2 280.65
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.)
1 720.90
38485
Mitral annulus, reconstruction of, after decalcification, when performed in association with valve surgery (H) (Anaes.) (Assist.)
817.10
38487
Mitral valve, open valvotomy of (H) (Anaes.) (Assist.)
1 720.90
38488
Valve replacement with bioprosthesis or mechanical prosthesis (H) (Anaes.) (Assist.)
1 909.60
38489
Valve replacement with allograft (subcoronary or cylindrical implant), or unstented xenograft (H) (Anaes.) (Assist.)
2 271.05
38490
Sub‑valvular structures, reconstruction and re‑implantation of, associated with mitral and tricuspid valve replacement (H) (Anaes.) (Assist.)
554.55
38493
Operative management of acute infective endocarditis, in association with heart valve surgery (H) (Anaes.) (Assist.)
1 957.60
38496
Artery harvesting (other than internal mammary), for coronary artery bypass (H) (Anaes.) (Assist.)
623.95
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.)
2 047.60
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 stand‑by 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.)
2 047.60
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.)
2 200.00
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 stand‑by 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.)
2 200.00
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.)
2 388.70
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 stand‑by 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.)
2 388.70
38505
Coronary endarterectomy, by open operation, including repair with one or more patch grafts, each vessel (H) (Anaes.) (Assist.)
277.25
38506
Left ventricular aneurysm, plication of (H) (Anaes.) (Assist.)
1 626.25
38507
Left ventricular aneurysm resection with primary repair (H) (Anaes.) (Assist.)
1 909.20
38508
Left ventricular aneurysm resection with patch reconstruction of the left ventricle (H) (Anaes.) (Assist.)
2 388.70
38509
Ischaemic ventricular septal rupture, repair of (H) (Anaes.) (Assist.)
2 388.70
38512
Division of accessory pathway, isolation procedure, procedure on atrioventricular node or perinodal tissues involving one atrial chamber only (H) (Anaes.) (Assist.)
2 098.45
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.)
2 671.95
38518
Ventricular arrhythmia with mapping and muscle ablation, with or without aneurysmeotomy (H) (Anaes.) (Assist.)
2 868.05
38550
Ascending thoracic aorta, repair or replacement of, not involving valve replacement or repair or coronary artery implantation (H) (Anaes.) (Assist.)
2 146.15
38553
Ascending thoracic aorta, repair or replacement of, with aortic valve replacement or repair, without implantation of coronary arteries (H) (Anaes.) (Assist.)
2 719.75
38556
Ascending thoracic aorta, repair or replacement of, with aortic valve replacement or repair, and implantation of coronary arteries (H) (Anaes.) (Assist.)
3 104.70
38559
Aortic arch and ascending thoracic aorta, repair or replacement of, not involving valve replacement or repair or coronary artery implantation (H) (Anaes.) (Assist.)
2 531.00
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.)
3 104.70
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.)
3 482.25
38568
Descending thoracic aorta, repair or replacement of, without shunt or cardiopulmonary bypass, by open exposure, percutaneous or endovascular means (H) (Anaes.) (Assist.)
1 862.95
38571
Descending thoracic aorta, repair or replacement of, using shunt or cardiopulmonary bypass (H) (Anaes.) (Assist.)
2 051.75
38572
Operative management of acute rupture or dissection, in conjunction with procedures on the thoracic aorta (H) (Anaes.) (Assist.)
1 987.05
38577
Cannulation for, and supervision and monitoring of, the administration of retrograde cerebral perfusion during deep hypothermic arrest (H) (Assist.)
554.55
38588
Cannulation of the coronary sinus for, and supervision of, the retrograde administration of blood or crystalloid for cardioplegia, including pressure monitoring (H) (Assist.)
416.05
38600
Central cannulation for cardiopulmonary bypass excluding post‑operative management, other than a service associated with a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)
1 532.00
38603
Peripheral cannulation for cardiopulmonary bypass excluding post‑operative management (H) (Anaes.) (Assist.)
958.40
38609
Intra‑aortic balloon pump, insertion of, by arteriotomy (H) (Anaes.) (Assist.)
479.15
38612
Intra‑aortic balloon pump, removal of, with closure of artery by direct suture (Anaes.) (Assist.)
537.10
38613
Intra‑aortic balloon pump, removal of, with closure of artery by patch graft (H) (Anaes.) (Assist.)
674.05
38615
Left or right ventricular assist device, insertion of (H) (Anaes.) (Assist.)
1 532.00
38618
Left and right ventricular assist device, insertion of (H) (Anaes.) (Assist.)
1 909.60
38621
Left or right ventricular assist device, removal of, as an independent procedure (H) (Anaes.) (Assist.)
762.35
38624
Left and right ventricular assist device, removal of, as an independent procedure (H) (Anaes.) (Assist.)
856.65
38627
Extra‑corporeal membrane oxygenation, bypass or ventricular assist device cannulae, adjustment and re‑positioning of, by open operation, in patients supported by these devices (H) (Anaes.) (Assist.)
669.60
38637
Patent diseased coronary artery bypass vein graft or grafts, dissection, disconnection and oversewing of (H) (Anaes.) (Assist.)
554.55
38640
Re‑operation 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.)
958.40
38643
Thoracotomy or sternotomy involving division of adhesions if the time taken to divide the adhesions exceeds 45 minutes (H) (Anaes.) (Assist.)
1 067.40
38647
Thoracotomy or sternotomy involving division of extensive adhesions if the time taken to divide the adhesions exceeds 2 hours (H) (Anaes.) (Assist.)
2 134.50
38650
Myomectomy or myotomy for hypertrophic obstructive cardiomyopathy (H) (Anaes.) (Assist.)
1 909.60
38653
Open heart surgery, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
1 909.60
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.)
1 224.60
38656
Thoracotomy or median sternotomy for post‑operative bleeding (H) (Anaes.) (Assist.)
958.40
38670
Cardiac tumour, excision of, involving the wall of the atrium or inter‑atrial septum, without patch or conduit reconstruction (H) (Anaes.) (Assist.)
1 909.20
38673
Cardiac tumour, excision of, involving the wall of the atrium or inter‑atrial septum, requiring reconstruction with patch or conduit (H) (Anaes.) (Assist.)
2 148.85
38677
Cardiac tumour arising from ventricular myocardium, partial thickness excision of (H) (Anaes.) (Assist.)
2 010.35
38680
Cardiac tumour arising from ventricular myocardium, full thickness excision of including repair or reconstruction (Anaes.) (Assist.)
2 384.55
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.)
1 067.40
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.)
1 924.10
38706
Aorta, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
1 822.40
38709
Aorta, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38712
Aortic interruption, repair of, for congenital heart disease (H) (Anaes.) (Assist.)
2 563.15
38715
Main pulmonary artery, banding, debanding or repair of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
1 706.30
38718
Main pulmonary artery, banding, debanding or repair of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38721
Vena cava, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
1 495.80
38724
Vena cava, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
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.)
1 495.80
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.)
2 134.50
38733
Systemic pulmonary or cavo‑pulmonary shunt, creation of, without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
1 495.80
38736
Systemic pulmonary or cavo‑pulmonary shunt, creation of, with cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38739
Atrial septectomy, with or without cardiopulmonary bypass, for congenital heart disease (H) (Anaes.) (Assist.)
1 924.10
38742
Atrial septal defect, closure by open exposure and direct suture or patch, for congenital heart disease (H) (Anaes.) (Assist.)
1 924.10
38745
Intra‑atrial baffle, insertion of, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38748
Ventricular septectomy, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38751
Ventricular septal defect, closure by direct suture or patch (H) (Anaes.) (Assist.)
2 134.50
38754
Intraventricular baffle or conduit, insertion of, for congenital heart disease (H) (Anaes.) (Assist.)
2 671.95
38757
Extracardiac conduit, insertion of, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38760
Extracardiac conduit, replacement of, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38763
Ventricular myectomy, for relief of ventricular obstruction, right or left, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38766
Ventricular augmentation, right or left, for congenital heart disease (H) (Anaes.) (Assist.)
2 134.50
38800
Thoracic cavity, aspiration of, for diagnostic purposes, other than a service associated with a service to which item 38803 applies
38.50
38803
Thoracic cavity, aspiration of, with therapeutic drainage (paracentesis), with or without diagnostic sample
76.90
38806
Intercostal drain, insertion of, not involving resection of rib (excluding after‑care) (Anaes.)
133.55
38809
Intercostal drain, insertion of, with pleurodesis and not involving resection of rib (excluding after‑care) (Anaes.)
164.55
38812
Percutaneous needle biopsy of lung (Anaes.)
209.15
Subdivision E—Subgroups 7 to 11 of Group T8
Group T8—Surgical operations
Item
Description
Fee ($)
Subgroup 7—Neurosurgical
39000
Lumbar puncture (Anaes.)
75.30
39003
Cisternal puncture (Anaes.)
85.65
39006
Ventricular puncture (not including burr‑hole) (Anaes.)
159.40
39009
Subdural haemorrhage, tap for, each tap (H) (Anaes.)
59.35
39012
Burr‑hole, single, preparatory to ventricular puncture or for inspection purpose—other than a service to which another item applies (H) (Anaes.)
237.60
39013
Injection under image intensification with one or more of contrast media, local anaesthetic or corticosteroid into one or more zygo‑apophyseal or costo‑transverse joints or one or more primary posterior rami of spinal nerves (Anaes.)
109.15
39015
Ventricular reservoir, external ventricular drain or intracranial pressure monitoring device, insertion of—including burr‑hole (excluding after‑care) (H) (Anaes.) (Assist.)
376.00
39018
Cerebrospinal fluid reservoir, insertion of (H) (Anaes.) (Assist.)
376.00
39100
Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes.)
237.60
39106
Neurectomy, intracranial, for trigeminal neuralgia (H) (Anaes.) (Assist.)
1 188.20
39109
Trigeminal gangliotomy by radiofrequency, balloon or glycerol (Anaes.)
443.70
39112
Cranial nerve, intracranial decompression of, using microsurgical techniques (H) (Anaes.) (Assist.)
1 541.50
39115
Percutaneous neurotomy of posterior divisions (or rami) of spinal nerves by any method, including any associated spinal, epidural or regional nerve block (payable once only in a 30 day period) (Anaes.)
75.30
39118
Percutaneous neurotomy for facet joint denervation by radio‑frequency probe or cryoprobe using radiological imaging control (Anaes.) (Assist.)
297.85
39121
Percutaneous cordotomy (Anaes.) (Assist.)
631.75
39124
Cordotomy or myelotomy, partial or total laminectomy for, or operation for dorsal root entry zone (Drez) lesion (H) (Anaes.) (Assist.)
1 616.80
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.)
298.05
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.)
361.90
39127
Subcutaneous reservoir and spinal catheter, insertion of, for the management of chronic intractable pain (H) (Anaes.)
473.65
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.)
659.95
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.)
674.15
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
127.80
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.)
159.40
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.)
340.60
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 (Anaes.)
159.40
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.)
159.40
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.)
605.35
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.)
674.15
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.)
905.10
39140
Epidural catheter, insertion of, under imaging control, with epidurogram and epidural therapeutic injection for lysis of adhesions (Anaes.)
292.85
39300
Cutaneous nerve (including digital nerve), primary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)
353.35
39303
Cutaneous nerve (including digital nerve), secondary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)
466.10
39306
Nerve trunk, primary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)
676.80
39309
Nerve trunk, secondary repair of, using microsurgical techniques (H) (Anaes.) (Assist.)
714.35
39312
Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (H) (Anaes.) (Assist.)
398.55
39315
Nerve trunk, nerve graft to, (cable graft) including harvesting of nerve graft using microsurgical techniques (H) (Anaes.) (Assist.)
1 030.20
39318
Cutaneous nerve (including digital nerve), nerve graft to, using microsurgical techniques (H) (Anaes.) (Assist.)
639.20
39321
Nerve, transposition of (H) (Anaes.) (Assist.)
473.65
39323
Percutaneous neurotomy by cryotherapy or radiofrequency lesion generator, other than a service to which another item applies (Anaes.) (Assist.)
276.80
39324
Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve, by open operation (Anaes.) (Assist.)
276.80
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.)
473.75
39330
Neurolysis by open operation without transposition, other than a service associated with a service to which item 39312 applies (H) (Anaes.) (Assist.)
276.80
39331
Carpal tunnel release (division of transverse carpal ligament), by any method (Anaes.)
276.80
39333
Brachial plexus, exploration of, other than a service to which another item in this Group applies (Anaes.) (Assist.)
398.55
39500
Vestibular nerve, section of, via posterior fossa (H) (Anaes.) (Assist.)
1 270.90
39503
Facio‑hypoglossal nerve or facio‑accessory nerve, anastomosis of (H) (Anaes.) (Assist.)
955.00
39600
Intracranial haemorrhage, burr‑hole craniotomy for—including burr‑holes (H) (Anaes.) (Assist.)
473.65
39603
Intracranial haemorrhage, osteoplastic craniotomy or extensive craniectomy and removal of haematoma (H) (Anaes.) (Assist.)
1 195.70
39606
Fractured skull, depressed or comminuted, operation for (H) (Anaes.) (Assist.)
797.10
39609
Fractured skull, compound, without dural penetration, operation for (H) (Anaes.) (Assist.)
955.00
39612
Fractured skull, compound, depressed or complicated, with dural penetration and brain laceration, operation for (H) (Anaes.) (Assist.)
1 120.45
39615
Fractured skull with rhinorrhoea or otorrhoea, cranioplasty and repair of (H) (Anaes.) (Assist.)
1 195.70
39640
Tumour involving anterior cranial fossa, removal of, involving craniotomy, radical excision of the skull base, and dural repair (H) (Anaes.) (Assist.)
3 031.65
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.)
3 187.25
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.)
3 653.60
39650
Tumour involving middle cranial fossa and infra‑temporal fossa, removal of, craniotomy and radical or sub‑total radical excision, with division and reconstruction of zygomatic arch, (intracranial procedure) (H) (Anaes.) (Assist.)
2 642.95
39653
Petro‑clival and clival tumour, removal of, by supra and infratentorial approaches for radical or sub‑total radical excision (intracranial procedure), other than a service to which item 39654 or 39656 applies (H) (Anaes.) (Assist.)
4 703.15
39654
Petro‑clival and clival tumour, removal of, by supra and infratentorial approaches for radical or sub‑total radical excision (intracranial procedure), conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)
3 420.50
39656
Petro‑clival and clival tumour, removal of, by supra and infratentorial approaches for radical or sub‑total radical excision (intracranial procedure), conjoint surgery, co‑surgeon (H) (Assist.)
2 565.30
39658
Tumour involving the clivus, radical or sub‑total radical excision of, involving transoral or transmaxillary approach (H) (Anaes.) (Assist.)
3 031.65
39660
Tumour or vascular lesion of cavernous sinus, radical excision of, involving craniotomy with or without intracranial carotid artery exposure (H) (Anaes.) (Assist.)
3 031.65
39662
Tumour or vascular lesion of foramen magnum, radical excision of, via transcondylar or far lateral suboccipital approach (H) (Anaes.) (Assist.)
3 031.65
39700
Skull tumour, benign or malignant, excision of, excluding cranioplasty (H) (Anaes.) (Assist.)
556.60
39703
Intracranial tumour, cyst or other brain tissue, burr‑hole and biopsy of, or drainage of, or both (H) (Anaes.) (Assist.)
519.00
39706
Intracranial tumour, biopsy or decompression of via osteoplastic flap or biopsy and decompression of via osteoplastic flap (H) (Anaes.) (Assist.)
1 112.85
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.)
1 586.75
39712
Craniotomy for removal of meningioma, pinealoma, cranio‑pharyngioma, intraventricular tumour or another intracranial tumour—other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)
2 865.00
39715
Pituitary tumour, removal of, by transcranial or transphenoidal approach (H) (Anaes.) (Assist.)
1 985.30
39718
Arachnoidal cyst, craniotomy for (H) (Anaes.) (Assist.)
872.30
39721
Craniotomy, involving osteoplastic flap, for re‑opening post‑operatively for haemorrhage, swelling, etc (H) (Anaes.) (Assist.)
797.10
39800
Aneurysm, clipping or reinforcement of sac (H) (Anaes.) (Assist.)
2 857.55
39803
Intracranial arteriovenous malformation, excision of (H) (Anaes.) (Assist.)
2 857.55
39806
Aneurysm, or arteriovenous malformation, intracranial proximal artery clipping of (H) (Anaes.) (Assist.)
1 285.75
39812
Intracranial aneurysm or arteriovenous fistula, ligation of cervical vessel or vessels (H) (Anaes.) (Assist.)
631.75
39815
Carotid‑cavernous fistula, obliteration of—combined cervical and intracranial procedure (Anaes.) (Assist.)
1 827.25
39818
Extracranial to intracranial bypass using superficial temporal artery (H) (Anaes.) (Assist.)
1 827.25
39821
Extracranial to intracranial bypass using saphenous vein graft (H) (Anaes.) (Assist.)
2 169.75
39900
Intracranial infection, drainage of, via burr‑hole—including burr‑hole (H) (Anaes.) (Assist.)
519.00
39903
Intracranial abscess, excision of (H) (Anaes.) (Assist.)
1 586.75
39906
Osteomyelitis of skull or removal of infected bone flap, craniectomy for (H) (Anaes.) (Assist.)
797.10
40000
Ventriculo‑cisternostomy (Torkildsen’s operation) (H) (Anaes.) (Assist.)
917.40
40003
Cranial or cisternal shunt diversion, insertion of (H) (Anaes.) (Assist.)
917.40
40006
Lumbar shunt diversion, insertion of (H) (Anaes.) (Assist.)
721.95
40009
Cranial, cisternal or lumbar shunt, revision or removal of (H) (Anaes.) (Assist.)
526.40
40012
Third ventriculostomy (open or endoscopic) with or without endoscopic septum pellucidotomy (H) (Anaes.) (Assist.)
1 030.20
40015
Subtemporal decompression (H) (Anaes.) (Assist.)
638.65
40018
Lumbar cerebrospinal fluid drain, insertion of (Anaes.)
159.40
40100
Meningocele, excision and closure of (H) (Anaes.) (Assist.)
691.75
40103
Myelomeningocele, excision and closure of, including skin flaps or Z plasty, if performed (H) (Anaes.) (Assist.)
1 015.25
40106
Arnold‑Chiari malformation, decompression of (H) (Anaes.) (Assist.)
1 030.20
40109
Encephalocoele, excision and closure of (H) (Anaes.) (Assist.)
1 112.85
40112
Tethered cord, release of, including lipomeningocele or diastematomyelia (H) (Anaes.) (Assist.)
1 428.75
40115
Craniostenosis, operation for—single suture (H) (Anaes.) (Assist.)
721.95
40118
Craniostenosis, operation for—more than one suture (H) (Anaes.) (Assist.)
955.00
40300
Intervertebral disc or discs, partial or total laminectomy for removal of (H) (Anaes.) (Assist.)
955.00
40301
Intervertebral disc or discs, microsurgical partial or total discectomy of (H) (Anaes.) (Assist.)
958.00
40303
Recurrent disc lesion or spinal stenosis, or both, partial or total laminectomy for—one level (H) (Anaes.) (Assist.)
1 090.35
40306
Spinal stenosis, partial or total laminectomy for, involving more than one vertebral interspace (disc level) (H) (Anaes.) (Assist.)
1 436.30
40309
Extradural tumour or abscess, partial or total laminectomy for (H) (Anaes.) (Assist.)
1 090.35
40312
Intradural lesion, partial or total laminectomy for, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
1 466.30
40315
Craniocervical junction lesion, transoral approach for (H) (Anaes.) (Assist.)
1 586.75
40316
Odontoid screw fixation (H) (Anaes.) (Assist.)
2 079.75
40318
Intramedullary tumour or arteriovenous malformation, partial or total laminectomy and radical excision of (H) (Anaes.) (Assist.)
1 985.30
40321
Posterior spinal fusion, other than a service to which items 40324 and 40327 apply (H) (Anaes.) (Assist.)
1 090.35
40324
Partial or total laminectomy followed by posterior fusion, performed by neurosurgeon and orthopaedic surgeon operating together—laminectomy, including after‑care (H) (Anaes.) (Assist.)
639.20
40327
Partial or total laminectomy followed by posterior fusion, performed by neurosurgeon and orthopaedic surgeon operating together—posterior fusion, including after‑care (H) (Assist.)
639.20
40330
Spinal rhizolysis involving exposure of spinal nerve roots—for lateral recess, exit foraminal stenosis, adhesive radiculopathy or extensive epidural fibrosis, at one or more levels—with or without partial or total laminectomy (H) (Anaes.) (Assist.)
955.00
40331
Cervical decompression of spinal cord with or without involvement of nerve roots, without fusion, one level, by any approach, other than a service to which item 40330 applies (H) (Anaes.) (Assist.)
955.00
40332
Cervical decompression of spinal cord with or without involvement of nerve roots, including anterior fusion, one level, other than a service to which item 40330 applies (H) (Anaes.) (Assist.)
1 558.30
40333
Cervical partial or total discectomy (anterior), without fusion (H) (Anaes.) (Assist.)
797.10
40334
Cervical decompression of spinal cord with or without involvement of nerve roots, without fusion, more than one level, by any approach, other than a service to which item 40330 applies (H) (Anaes.) (Assist.)
1 053.90
40335
Cervical decompression of spinal cord with or without involvement of nerve roots, including anterior fusion, more than one level, by any approach, other than a service to which item 40330 applies (H) (Anaes.) (Assist.)
1 935.60
40336
Intradiscal injection of chymopapain (discase)—one disc (H) (Anaes.) (Assist.)
315.90
40339
Hydromyelia, plugging of obex for, with or without duroplasty (H) (Anaes.) (Assist.)
1 586.75
40342
Hydromyelia, craniotomy and partial or total laminectomy for, with cavity packing and CSF shunt (H) (Anaes.) (Assist.)
1 466.30
40345
Thoracic decompression of spinal cord with or without involvement of nerve roots, via pedicle or costotransversectomy (H) (Anaes.) (Assist.)
1 365.00
40348
Thoracic decompression of spinal cord via thoracotomy with vertebrectomy, not including stabilisation procedure (H) (Anaes.) (Assist.)
1 733.10
40351
Thoraco‑lumbar or high lumbar anterior decompression of spinal cord, not including stabilisation procedure (H) (Anaes.) (Assist.)
1 733.10
40600
Cranioplasty, reconstructive (H) (Anaes.) (Assist.)
955.00
40700
Corpus callosum, anterior section of, for epilepsy (H) (Anaes.) (Assist.)
1 744.65
40703
Corticectomy, topectomy or partial lobectomy for epilepsy (H) (Anaes.) (Assist.)
1 466.30
40706
Hemispherectomy for intractable epilepsy (Anaes.) (Assist.)
2 143.10
40709
Burr‑hole placement of intracranial depth or surface electrodes (H) (Anaes.) (Assist.)
519.00
40712
Intracranial electrode placement via craniotomy (H) (Anaes.) (Assist.)
1 045.20
40800
Stereotactic anatomical localisation, as an independent procedure (Anaes.) (Assist.)
638.65
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.)
1 745.80
40803
Intracranial stereotactic procedure by any method, other than a service to which item 40800 or 40801 applies (Anaes.) (Assist.)
1 195.70
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, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
2 264.45
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, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
3 963.00
40852
Deep brain stimulation (unilateral) subcutaneous placement of neuro‑stimulator receiver or pulse generator for the treatment of:
(a) Parkinson’s disease, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
340.60
40854
Deep brain stimulation (unilateral) revision or removal of brain electrode for the treatment of:
(a) Parkinson’s disease, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
526.40
40856
Deep brain stimulation (unilateral) removal or replacement of neurostimulator receiver or pulse generator for the treatment of:
(a) Parkinson’s disease, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
255.45
40858
Deep brain stimulation (unilateral) placement, removal or replacement of extension lead for the treatment of:
(a) Parkinson’s disease, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
526.40
40860
Deep brain stimulation (unilateral) target localisation incorporating anatomical and physiological techniques, including intra‑operative clinical evaluation, for the insertion of a single neurostimulation wire for the treatment of:
(a) Parkinson’s disease, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia where the patient’s symptoms cause severe disability
(H) (Anaes.) (Assist.)
2 022.70
40862
Deep brain stimulation (unilateral) electronic analysis and programming of neurostimulator pulse generator for the treatment of:
(a) Parkinson’s disease, where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
(b) essential tremor or dystonia, where the patient’s symptoms cause severe disability
(Anaes.)
189.70
40903
Neuroendoscopy, for inspection of an intraventricular lesion, with or without biopsy including burr‑hole (H) (Anaes.) (Assist.)
554.55
40905
Craniotomy, performed in association with items 45767, 45776, 45782 and 45785 for the correction of craniofacial abnormalities (Anaes.)
601.70
Subgroup 8—ear, nose and throat
41500
Ear, foreign body (other than ventilating tube) in, removal of, other than by simple syringing (Anaes.)
82.50
41503
Ear, removal of foreign body in, involving incision of external auditory canal (Anaes.)
238.80
41506
Aural polyp, removal of (Anaes.)
144.00
41509
External auditory meatus, surgical removal of keratosis obturans from, other than a service to which another item in this Group applies (Anaes.)
162.95
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.)
585.90
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.)
384.55
41518
External auditory meatus, removal of exostoses in (H) (Anaes.) (Assist.)
928.75
41521
Correction of auditory canal stenosis, including meatoplasty, with or without grafting (H) (Anaes.) (Assist.)
988.85
41524
Reconstruction of external auditory canal, being a service associated with a service to which items 41557, 41560 and 41563 apply (H) (Anaes.) (Assist.)
285.70
41527
Myringoplasty, trans‑canal approach (Rosen incision) (H) (Anaes.) (Assist.)
587.60
41530
Myringoplasty, post‑aural or endaural approach with or without mastoid inspection (H) (Anaes.)
957.30
41533
Atticotomy without reconstruction of the bony defect, with or without myringoplasty (H) (Anaes.) (Assist.)
1 144.30
41536
Atticotomy with reconstruction of the bony defect with or without myringoplasty (H) (Anaes.) (Assist.)
1 281.70
41539
Ossicular chain reconstruction (H) (Anaes.) (Assist.)
1 089.90
41542
Ossicular chain reconstruction and myringoplasty (H) (Anaes.) (Assist.)
1 194.25
41545
Mastoidectomy (cortical) (H) (Anaes.) (Assist.)
521.25
41548
Obliteration of the mastoid cavity (H) (Anaes.) (Assist.)
691.75
41551
Mastoidectomy, intact wall technique, with myringoplasty (H) (Anaes.) (Assist.)
1 593.05
41554
Mastoidectomy, intact wall technique, with myringoplasty and ossicular chain reconstruction (H) (Anaes.) (Assist.)
1 876.95
41557
Mastoidectomy (radical or modified radical) (H) (Anaes.) (Assist.)
1 089.90
41560
Mastoidectomy (radical or modified radical) and myringoplasty (H) (Anaes.)
1 194.25
41563
Mastoidectomy (radical or modified radical), myringoplasty and ossicular chain reconstruction (H) (Anaes.) (Assist.)
1 478.40
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.)
1 911.80
41566
Revision of mastoidectomy (radical, modified radical or intact wall), including myringoplasty (H) (Anaes.) (Assist.)
1 089.90
41569
Decompression of facial nerve in its mastoid portion (H) (Anaes.) (Assist.)
1 194.25
41572
Labyrinthotomy or destruction of labyrinth (H) (Anaes.) (Assist.)
1 033.20
41575
Cerebello‑pontine angle tumour, removal of by 2 surgeons operating conjointly, by transmastoid, translabyrinthine or retromastoid approach—transmastoid, translabyrinthine or retromastoid procedure (including after‑care) (H) (Anaes.) (Assist.)
2 435.70
41576
Cerebello‑pontine angle tumour, removal of, by transmastoid, translabyrinthine or retromastoid approach (intracranial procedure) (including after‑care) other than a service to which item 41578 or 41579 applies (H) (Anaes.) (Assist.)
3 653.60
41578
Cerebello‑pontine angle tumour, removal of, by transmastoid, translabyrinthine or retromastoid approach (intracranial procedure)—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)
2 435.70
41579
Cerebello‑pontine angle tumour, removal of, by transmastoid, translabyrinthine or retromastoid approach (intracranial procedure)—conjoint surgery, co‑surgeon (H) (Assist.)
1 826.75
41581
Tumour involving infra‑emporal fossa, removal of, involving craniotomy and radical excision of (H) (Anaes.) (Assist.)
2 801.55
41584
Partial temporal bone resection for removal of tumour involving mastoidectomy with or without decompression of facial nerve (H) (Anaes.) (Assist.)
1 922.65
41587
Total temporal bone resection for removal of tumour (H) (Anaes.) (Assist.)
2 618.60
41590
Endolymphatic sac, transmastoid decompression with or without drainage of (H) (Anaes.) (Assist.)
1 194.25
41593
Translabyrinthine vestibular nerve section (H) (Anaes.) (Assist.)
1 556.50
41596
Retrolabyrinthine vestibular nerve section or cochlear nerve section, or both (H) (Anaes.) (Assist.)
1 739.50
41599
Internal auditory meatus, exploration by middle cranial fossa approach with cranial nerve decompression (H) (Anaes.) (Assist.)
1 739.50
41603
Osseo‑integration 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
503.85
41604
Osseo‑integration 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
186.50
41608
Stapedectomy (H) (Anaes.) (Assist.)
1 089.90
41611
Stapes mobilisation (H) (Anaes.) (Assist.)
701.30
41614
Round window surgery including repair of cochleotomy (Anaes.) (Assist.)
1 089.90
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.)
1 089.90
41617
Cochlear implant, insertion of, including mastoidectomy (H) (Anaes.) (Assist.)
1 895.20
41620
Glomus tumour, transtympanic removal of (H) (Anaes.) (Assist.)
824.55
41623
Glomus tumour, transmastoid removal of, including mastoidectomy (H) (Anaes.) (Assist.)
1 194.25
41626
Abscess or inflammation of middle ear, operation for (excluding after‑care) (Anaes.)
144.00
41629
Middle ear, exploration of (H) (Anaes.) (Assist.)
521.25
41632
Middle ear, insertion of tube for drainage of (including myringotomy) (Anaes.)
238.80
41635
Clearance of middle ear for granuloma, cholesteatoma and polyp, one or more, with or without myringoplasty (Anaes.) (Assist.)
1 144.30
41638
Clearance of middle ear for granuloma, cholesteatoma and polyp, one or more, with or without myringoplasty with ossicular chain reconstruction (H) (Anaes.) (Assist.)
1 428.35
41641
Perforation of tympanum, cauterisation or diathermy of (Anaes.)
47.45
41644
Excision of rim of eardrum perforation, other than a service associated with myringoplasty (Anaes.)
142.80
41647
Ear toilet requiring use of operating microscope and microinspection of tympanic membrane with or without general anaesthesia (Anaes.)
109.90
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.)
109.90
41653
Examination of nasal cavity or post‑nasal space or nasal cavity and post‑nasal space, under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)
71.95
41656
Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding after‑care) (Anaes.)
122.85
41659
Nose, removal of foreign body in, other than by simple probing (Anaes.)
77.55
41662
Nasal polyp or polypi (simple), removal of
82.50
41665
Nasal polyp or polypi, removal of (G) (H) (Anaes.)
172.50
41668
Nasal polyp or polypi, removal of (S) (H) (Anaes.)
219.95
41671
Nasal septum, septoplasty, submucous resection or closure of septal perforation (H) (Anaes.)
483.25
41672
Nasal septum, reconstruction of (H) (Anaes.) (Assist.)
602.85
41674
Cauterisation (other than by chemical means) or cauterisation by chemical means when performed under general anaesthesia or diathermy of septum, turbinates or pharynx—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.)
100.50
41677
Nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)
90.00
41680
Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes.)
162.95
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 post‑operative period of a nasal operation (Anaes.)
117.20
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.)
71.95
41689
Turbinectomy or turbinectomies, partial or total, unilateral (H) (Anaes.)
136.50
41692
Turbinates, submucous resection of, unilateral (H) (Anaes.)
178.05
41695
Nasal turbinates, cryotherapy to (Anaes.)
100.00
41698
Maxillary antrum, proof puncture and lavage of (Anaes.)
32.55
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.)
91.90
41704
Maxillary antrum, lavage of—each attendance at which the procedure is performed, including any associated consultation (Anaes.)
36.30
41707
Maxillary artery, transantral ligation of (H) (Anaes.) (Assist.)
448.55
41710
Antrostomy (radical) (H) (Anaes.) (Assist.)
521.25
41713
Antrostomy (radical) with transantral ethmoidectomy or transantral vidian neurectomy (H) (Anaes.) (Assist.)
606.50
41716
Antrum, intranasal operation on or removal of foreign body from (H) (Anaes.) (Assist.)
295.70
41719
Antrum, drainage of, through tooth socket (Anaes.)
117.55
41722
Oro‑antral fistula, plastic closure of (Anaes.) (Assist.)
587.60
41725
Ethmoidal artery or arteries, transorbital ligation of (unilateral) (H) (Anaes.) (Assist.)
448.55
41728
Lateral rhinotomy with removal of tumour (H) (Anaes.) (Assist.)
897.30
41729
Dermoid of nose, excision of, with intranasal extension (H) (Anaes.) (Assist.)
568.65
41731
Fronto‑nasal ethmoidectomy by external approach with or without sphenoidectomy (H) (Anaes.) (Assist.)
777.10
41734
Radical fronto‑ethmoidectomy with osteoplastic flap (H) (Anaes.) (Assist.)
1 014.05
41737
Frontal sinus, or ethmoidal sinuses on the one side, intranasal operation on (H) (Anaes.) (Assist.)
483.25
41740
Frontal sinus, catheterisation of (H) (Anaes.)
58.80
41743
Frontal sinus, trephine of (H) (Anaes.) (Assist.)
337.45
41746
Frontal sinus, radical obliteration of (Anaes.) (Assist.)
777.10
41749
Ethmoidal sinuses, external operation on (H) (Anaes.) (Assist.)
606.50
41752
Sphenoidal sinus, intranasal operation on (H) (Anaes.) (Assist.)
295.70
41755
Eustachian tube, catheterisation of (Anaes.)
46.50
41758
Division of pharyngeal adhesions (Anaes.)
117.55
41761
Post nasal space, direct examination of, with or without biopsy (Anaes.)
122.85
41764
Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx and larynx, one or more of these procedures, unilateral or bilateral examination of (Anaes.)
122.85
41767
Nasopharyngeal angiofibroma, removal of (Anaes.) (Assist.)
737.00
41770
Pharyngeal pouch, removal of, with or without cricopharyngeal myotomy (H) (Anaes.) (Assist.)
701.30
41773
Pharyngeal pouch, endoscopic resection of (Dohlman’s operation) (H) (Anaes.) (Assist.)
587.60
41776
Cricopharyngeal myotomy with or without inversion of pharyngeal pouch (H) (Anaes.) (Assist.)
585.90
41779
Pharyngotomy (lateral), with or without total excision of tongue (H) (Anaes.) (Assist.)
701.30
41782
Partial pharyngectomy via pharyngotomy (Anaes.) (Assist.)
952.10
41785
Partial pharyngectomy via pharyngotomy with partial or total glossectomy (H) (Anaes.) (Assist.)
1 181.15
41786
Uvulopalatopharyngoplasty, with or without tonsillectomy, by any means (H) (Anaes.) (Assist.)
737.00
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.)
568.65
41788
Tonsils or tonsils and adenoids, removal of, in a person aged less than 12 years (G) (H) (Anaes.)
219.95
41789
Tonsils or tonsils and adenoids, removal of, in a person aged less than 12 years (S) (H) (Anaes.)
295.70
41792
Tonsils or tonsils and adenoids, removal of, in a person 12 years of age or over (G) (H) (Anaes.)
276.80
41793
Tonsils or tonsils and adenoids, removal of, in a person 12 years of age or over (S) (H) (Anaes.)
371.50
41796
Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthesia, following removal of (G) (H) (Anaes.)
113.70
41797
Tonsils or tonsils and adenoids, arrest of haemorrhage requiring general anaesthesia, following removal of (S) (H) (Anaes.)
144.00
41800
Adenoids, removal of (G) (H) (Anaes.)
117.55
41801
Adenoids, removal of (S) (H) (Anaes.)
162.95
41804
Lingual tonsil or lateral pharyngeal bands, removal of (H) (Anaes.)
90.00
41807
Peritonsillar abscess (quinsy), incision of (Anaes.)
70.10
41810
Uvulotomy or uvulectomy (Anaes.)
35.60
41813
Vallecular or pharyngeal cysts, removal of (H) (Anaes.) (Assist.)
356.35
41816
Oesophagoscopy (with rigid oesophagoscope) (Anaes.)
185.60
41819
Dilatation of stricture of upper gastro‑intestinal tract using bougie or balloon over endoscopically inserted guidewire, including endoscopy with flexible or rigid endoscope (Anaes.)
348.95
41820
Dilatation of stricture of upper gastro‑intestinal tract using bougie or balloon over endoscopically inserted guidewire, including endoscopy with flexible or rigid endoscope, if the use of imaging intensification is clinically indicated (Anaes.)
418.75
41822
Oesophagoscopy (with rigid oesophagoscope) with biopsy (H) (Anaes.)
238.80
41825
Oesophagoscopy (with rigid oesophagoscope) with removal of foreign body (H) (Anaes.) (Assist.)
356.35
41828
Oesophageal stricture, dilatation of, without oesophagoscopy (Anaes.)
52.20
41831
Oesophagus, endoscopic pneumatic dilatation of (Anaes.) (Assist.)
357.00
41832
Oesophagus, balloon dilatation of, using interventional imaging techniques (Anaes.)
228.50
41834
Laryngectomy (total) (H) (Anaes.) (Assist.)
1 289.15
41837
Vertical hemi‑laryngectomy including tracheostomy (H) (Anaes.) (Assist.)
1 236.05
41840
Supraglottic laryngectomy including tracheostomy (H) (Anaes.) (Assist.)
1 519.80
41843
Laryngopharyngectomy or primary restoration of alimentary continuity after laryngopharyngectomy using stomach or bowel (H) (Anaes.) (Assist.)
1 336.45
41846
Larynx, direct examination of the supraglottic, glottic and subglottic regions, other than a service associated with another procedure on the larynx or with the administration of a general anaesthetic (Anaes.)
185.60
41849
Larynx, direct examination of, with biopsy (H) (Anaes.) (Assist.)
272.90
41852
Larynx, direct examination of, with removal of tumour (H) (Anaes.) (Assist.)
295.70
41855
Microlaryngoscopy (H) (Anaes.) (Assist.)
288.20
41858
Microlaryngoscopy with removal of juvenile papillomata (H) (Anaes.) (Assist.)
494.15
41861
Microlaryngoscopy with removal of benign lesions of the larynx by laser surgery (H) (Anaes.) (Assist.)
604.30
41864
Microlaryngoscopy with removal of tumour (H) (Anaes.) (Assist.)
407.50
41867
Microlaryngoscopy with arytenoidectomy (H) (Anaes.) (Assist.)
613.40
41868
Laryngeal web, division of, using microlarygoscopic techniques (H) (Anaes.)
388.70
41870
Injection of vocal cord by teflon, fat, collagen or gelfoam (H) (Anaes.) (Assist.)
454.85
41873
Larynx, fractured, operation for (Anaes.) (Assist.)
587.60
41876
Larynx, external operation on, or laryngofissure, with or without cordectomy (Anaes.) (Assist.)
587.60
41879
Laryngoplasty or tracheoplasty, including tracheostomy (H) (Anaes.) (Assist.)
952.10
41880
Tracheostomy by a percutaneous technique using sequential dilatation or partial splitting method to allow insertion of a cuffed tracheostomy tube (H) (Anaes.)
254.15
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.)
401.75
41884
Cricothyrostomy by direct stab or Seldinger technique, using mini tracheostomy device (H) (Anaes.)
91.05
41885
Trache‑oesophageal fistula, formation of, as a secondary procedure following laryngectomy, including associated endoscopic procedures (Anaes.) (Assist.)
287.90
41886
Trachea, removal of foreign body in (Anaes.)
178.05
41889
Bronchoscopy, as an independent procedure (Anaes.)
178.05
41892
Bronchoscopy with one or more endobronchial biopsies or other diagnostic or therapeutic procedures (Anaes.)
235.05
41895
Bronchus, removal of foreign body in (H) (Anaes.) (Assist.)
367.75
41898
Fibreoptic bronchoscopy with one or more transbronchial lung biopsies, with or without bronchial or broncho‑alveolar lavage, with or without the use of interventional imaging (Anaes.) (Assist.)
256.95
41901
Endoscopic laser resection of endobronchial tumours for relief of obstruction including any associated endoscopic procedures (H) (Anaes.) (Assist.)
604.30
41904
Bronchoscopy with dilatation of tracheal stricture (Anaes.)
246.50
41905
Trachea or bronchus, dilatation of stricture and endoscopic insertion of stent (H) (Anaes.) (Assist.)
453.35
41907
Nasal septum button, insertion of (Anaes.)
122.85
41910
Duct of major salivary gland, transposition of (H) (Anaes.) (Assist.)
390.25
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.)
102.50
42506
Eye, enucleation of, with or without sphere implant (Anaes.) (Assist.)
481.25
42509
Eye, enucleation of, with insertion of integrated implant (H) (Anaes.) (Assist.)
609.05
42510
Eye, enucleation of, with insertion of hydroxy apatite implant or similar coralline implant (H) (Anaes.) (Assist.)
702.05
42512
Globe, evisceration of (Anaes.) (Assist.)
481.25
42515
Globe, evisceration of, and insertion of intrascleral ball or cartilage (H) (Anaes.) (Assist.)
609.05
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.)
353.35
42521
Anophthalmic socket, treatment of, by insertion of a wired‑in conformer, integrated implant or dermofat graft, as a secondary procedure (H) (Anaes.) (Assist.)
1 203.20
42524
Orbit, skin graft to, as a delayed procedure (Anaes.)
204.60
42527
Contracted socket, reconstruction including mucous membrane grafting and stent mould (H) (Anaes.) (Assist.)
406.05
42530
Orbit, exploration with or without biopsy, requiring removal of bone (H) (Anaes.) (Assist.)
631.75
42533
Orbit, exploration of, with drainage or biopsy not requiring removal of bone (H) (Anaes.) (Assist.)
406.05
42536
Orbit, exenteration of, with or without skin graft and with or without temporalis muscle transplant (H) (Anaes.) (Assist.)
834.60
42539
Orbit, exploration of, with removal of tumour or foreign body, requiring removal of bone (H) (Anaes.) (Assist.)
1 188.20
42542
Orbit, exploration of anterior aspect with removal of tumour or foreign body (H) (Anaes.) (Assist.)
503.85
42543
Orbit, exploration of retrobulbar aspect with removal of tumour or foreign body (H) (Anaes.) (Assist.)
883.85
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.)
1 278.35
42548
Optic nerve meninges, incision of (H) (Anaes.) (Assist.)
759.40
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.)
631.75
42554
Eye, penetrating wound or rupture of, with incarceration or prolapse of uveal tissue—repair (H) (Anaes.) (Assist.)
737.00
42557
Eye, penetrating wound or rupture of, with incarceration of lens or vitreous—repair (H) (Anaes.) (Assist.)
1 030.20
42563
Intraocular foreign body, removal from anterior segment (Anaes.) (Assist.)
519.00
42569
Intraocular foreign body, removal from posterior segment (H) (Anaes.) (Assist.)
1 030.20
42572
Orbital abscess or cyst, drainage of (Anaes.)
117.35
42573
Dermoid, periorbital, excision of (Anaes.)
227.45
42574
Dermoid, orbital, excision of (Anaes.) (Assist.)
483.25
42575
Tarsal cyst, extirpation of (Anaes.)
82.75
42581
Ectropion or entropion, tarsal cauterisation of (Anaes.)
117.35
42584
Tarsorrhaphy (Anaes.) (Assist.)
276.80
42587
Trichiasis, treatment of by cryotherapy, laser or electrolysis—each eyelid (Anaes.)
51.95
42590
Canthoplasty, medial or lateral (Anaes.) (Assist.)
338.35
42593
Lacrimal gland, excision of palpebral lobe (H) (Anaes.)
204.60
42596
Lacrimal sac, excision of, or operation on (Anaes.) (Assist.)
503.85
42599
Lacrimal canalicular system, establishment of patency by closed operation using silicone tubes or similar, one eye (Anaes.) (Assist.)
631.75
42602
Lacrimal canalicular system, establishment of patency by open operation, one eye (Anaes.) (Assist.)
631.75
42605
Lacrimal canaliculus, immediate repair of (Anaes.) (Assist.)
466.10
42608
Lacrimal drainage by insertion of glass tube, as an independent procedure (Anaes.) (Assist.)
300.75
42610
Nasolacrimal tube (unilateral), removal or replacement of, or lacrimal passages, probing for obstruction, unilateral, with or without lavage—under general anaesthesia (Anaes.)
96.25
42611
Nasolacrimal tube (bilateral), removal or replacement of, or lacrimal passages, probing for obstruction, bilateral, with or without lavage—under general anaesthesia (Anaes.)
144.35
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 after‑care)
48.30
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 after‑care)
72.25
42617
Punctum snip operation (Anaes.)
136.95
42620
Punctum, occlusion of, by use of a plug (Anaes.)
52.65
42622
Punctum, permanent occlusion of, by use of electrical cautery (Anaes.)
82.75
42623
Dacryocystorhinostomy (H) (Anaes.) (Assist.)
699.45
42626
Dacryocystorhinostomy if a previous dacryocystorhinostomy has been performed (Anaes.) (Assist.)
1 128.05
42629
Conjunctivorhinostomy including dacryocystorhinostomy and fashioning of conjunctival flaps (H) (Anaes.) (Assist.)
849.70
42632
Conjunctival peritomy or repair of corneal laceration by conjunctival flap (Anaes.)
117.35
42635
Corneal perforations, sealing of, with tissue adhesive (Anaes.) (Assist.)
300.75
42638
Conjunctival graft over cornea (Anaes.) (Assist.)
376.00
42641
Autoconjunctival transplant, or mucous membrane graft (Anaes.) (Assist.)
488.75
42644
Cornea or sclera, complete removal of embedded foreign body from—not more than once on the same day by the same practitioner (excluding after‑care) (Anaes.)
72.15
42647
Corneal scars, removal of, by partial keratectomy, other than a service associated with a service to which item 42686 applies (Anaes.)
204.60
42650
Cornea, epithelial debridement for corneal ulcer or corneal erosion (excluding after‑care) (Anaes.)
72.15
42651
Cornea, epithelial debridement for eliminating band keratopathy (Anaes.)
160.80
42653
Cornea, transplantation of (H) (Anaes.) (Assist.)
1 307.75
42656
Cornea, transplantation of, second and subsequent procedures (H) (Anaes.) (Assist.)
1 669.45
42662
Sclera, transplantation of, full thickness, including collection of donor material (H) (Anaes.) (Assist.)
902.30
42665
Sclera, transplantation of, superficial or lamellar, including collection of donor material (Anaes.) (Assist.)
601.65
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
141.95
42668
Corneal sutures, removal of, not earlier than 6 weeks after operation requiring use of slit lamp or operating microscope (Anaes.)
75.30
42672
Corneal incisions, to correct corneal astigmatism of more than 11/2 diopters following anterior segment surgery, including appropriate measurements and calculations, performed as an independent procedure (Anaes.) (Assist.)
902.30
42673
Additional corneal incisions, to correct corneal astigmatism of more than 11/2 diopters, including appropriate measurements and calculations, performed in conjunction with other anterior segment surgery (Anaes.) (Assist.)
451.10
42676
Conjunctiva, biopsy of, as an independent procedure
115.70
42677
Conjunctiva, cautery of, including treatment of pannus—each attendance at which treatment is given including any associated consultation (Anaes.)
60.95
42680
Conjunctiva, cryotherapy to, for melanotic lesions or similar using CO2 or N20 (Anaes.)
300.75
42683
Conjunctival cysts, removal of (H) (Anaes.)
120.35
42686
Pterygium, removal of (Anaes.)
273.65
42689
Pinguecula, removal of, other than a service associated with the fitting of contact lenses (Anaes.)
117.35
42692
Limbic tumour, removal of, excluding Pterygium (Anaes.) (Assist.)
276.80
42695
Limbic tumour, excision of, requiring keratectomy or sclerectomy, excluding Pterygium (Anaes.) (Assist.)
451.10
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.)
594.75
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.)
331.70
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.)
760.65
42703
Intraocular lens or iris prosthesis, insertion of, into the posterior chamber with fixation to the iris or sclera (Anaes.) (Assist.)
572.05
42704
Intraocular lens, removal or repositioning of by open operation—other than a service associated with a service to which item 42701 applies (Anaes.)
466.10
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.)
797.10
42710
Intraocular lens, removal of, and replacement with a lens inserted into the posterior chamber and fixated to the iris or sclera (Anaes.) (Assist.)
902.30
42713
Iris suturing, McCannell technique or similar, for fixation of intraocular lens or repair of iris defect (Anaes.) (Assist.)
376.00
42716
Cataract, juvenile, removal of, including subsequent needlings (Anaes.) (Assist.)
1 195.70
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, 42716, 42725 or 42731 applies (Anaes.) (Assist.)
519.00
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
(H) (Anaes.) (Assist.)
1 338.45
42731
Limbal or pars plana lensectomy combined with vitrectomy, other than a service associated with item 42698, 42702, 42719 or 42725 (H) (Anaes.) (Assist.)
1 519.00
42734
Capsulotomy, other than by laser (Anaes.) (Assist.)
300.75
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
300.75
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.)
300.75
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.)
300.75
42741
Posterior juxtascleral depot injection of a therapeutic substance, for the treatment of subfoveal choroidal neovascularisation due to age‑related macular degeneration, one or more of (Anaes.)
300.75
42743
Anterior chamber, irrigation of blood from, as an independent procedure (Anaes.) (Assist.)
631.75
42744
Needle revision of glaucoma filtration bleb, following glaucoma filtering procedure (Anaes.)
300.55
42746
Glaucoma, filtering operation for, if conservative therapies have failed, are likely to fail, or are contraindicated (H) (Anaes.) (Assist.)
955.00
42749
Glaucoma, filtering operation for, if previous filtering operation has been performed (H) (Anaes.) (Assist.)
1 195.70
42752
Glaucoma, insertion of drainage device incorporating an extraocular reservoir for, such as a Molteno device (H) (Anaes.) (Assist.)
1 338.45
42755
Glaucoma, removal of drainage device incorporating an extraocular reservoir for, such as a Molteno device (H) (Anaes.) (Assist.)
165.45
42758
Goniotomy (H) (Anaes.) (Assist.)
699.45
42761
Division of anterior or posterior synechiae, as an independent procedure, other than by laser (Anaes.) (Assist.)
519.00
42764
Iridectomy (including excision of tumour of iris) or iridotomy, as an independent procedure, other than by laser (Anaes.) (Assist.)
519.00
42767
Tumour, involving ciliary body or ciliary body and iris, excision of (H) (Anaes.) (Assist.)
1 090.35
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.)
294.80
42773
Detached retina, pneumatic retinopexy for, other than a service associated with a service to which item 42776 applies (Anaes.) (Assist.)
902.30
42776
Detached retina, buckling or resection operation for (H) (Anaes.) (Assist.)
1 338.45
42779
Detached retina, revision of scleral buckling operation for (H) (Anaes.) (Assist.)
1 669.45
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.)
451.10
42783
Laser trabeculoplasty, for the treatment of glaucoma—each treatment to one eye—if it can be demonstrated that a fifth or subsequent treatment to that eye (including any treatments to which item 42782 applies) is indicated in a 2 year period (Anaes.) (Assist.)
451.10
42785
Laser iridotomy—each treatment episode to one eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
353.35
42786
Laser iridotomy—each treatment episode to one eye—if it can be demonstrated that a thirdor subsequent treatment to that eye (including any treatments to which item 42785 applies) is indicated in a 2 year period (Anaes.) (Assist.)
353.35
42788
Laser capsulotomy—each treatment episode to one eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
353.35
42789
Laser capsulotomy—each treatment episode to one eye—if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42788 applies) is indicated in a 2 year period (Anaes.) (Assist.)
353.35
42791
Laser vitreolysis or corticolysis of lens material or fibrinolysis—each treatment to one eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
353.35
42792
Laser vitreolysis or corticolysis of lens material or fibrinolysis—each treatment to one eye—if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42791 applies) is indicated in a 2 year period (Anaes.) (Assist.)
353.35
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.)
67.65
42801
Episcleral radioactive plaque (Ruthenium 106 or Iodine 125), for the treatment of choroidal melanomas, insertion of (H) (Anaes.) (Assist.)
1 049.70
42802
Episcleral radioactive plaque (Ruthenium 106 or Iodine 125), for the treatment of choroidal melanomas, removal of (H) (Anaes.) (Assist.)
524.70
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 (Anaes.)
586.50
42806
Iris tumour, laser photocoagulation of (Anaes.) (Assist.)
353.35
42807
Photomydriasis, laser
355.80
42808
Laser peripheral iridoplasty
355.80
42809
Retina, photocoagulation of, other than a service associated with photodynamic therapy with verteporfin (Anaes.) (Assist.)
451.10
42810
Phototherapeutic keratectomy, by laser, for corneal scarring or disease, excluding surgery for refractive error (Anaes.)
567.70
42811
Transpupillary thermotherapy, for choroidal and retinal tumours or vascular malformations (Anaes.)
451.10
42812
Removal of scleral buckling material, from an eye having undergone previous scleral buckling surgery (Anaes.)
165.45
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.)
631.75
42818
Retina, cryotherapy to, as an independent procedure, or when performed in association with item 42770 or 42809 (Anaes.)
586.50
42821
Ocular transillumination, for the diagnosis and measurement of intraocular tumours (Anaes.)
90.35
42824
Retrobulbar injection of alcohol or other drug, as an independent procedure
69.90
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.)
586.50
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.)
729.45
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.)
699.45
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.)
872.30
42845
Readjustment of adjustable sutures, one or both eyes, as an independent procedure following an operation for correction of squint (Anaes.)
189.40
42848
Squint, muscle transplant for (Hummelsheim type, or similar operation) on a patient aged 15 years or over (H) (Anaes.) (Assist.)
699.45
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 extra‑ocular operations on his or her eye or eyes; or
(c) has concurrent thyroid eye disease (H) (Anaes.) (Assist.)
872.30
42854
Ruptured medial palpebral ligament or ruptured extra‑ocular muscle, repair of (Anaes.) (Assist.)
406.05
42857
Resuturing of wound following intraocular procedures with or without excision of prolapsed iris (Anaes.) (Assist.)
406.05
42860
Eyelid (upper or lower), scleral or Goretex or other non‑autogenous graft to, with recession of the lid retractors (Anaes.) (Assist.)
902.30
42863
Eyelid, recession of (Anaes.) (Assist.)
774.55
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.)
751.85
42869
Eyelid closure in facial nerve paralysis, insertion of foreign implant for (Anaes.) (Assist.)
549.00
42872
Eyebrow, elevation of, for paretic states (Anaes.)
240.70
43021
Photodynamic therapy, one eye, including the infusion of vertoporfin continuously through a peripheral vein, using a non‑thermal laser at a wavelength of 689 nm, for the treatment of choroidal neovascularisation
455.05
43022
Photodynamic therapy, both eyes, including the infusion of vertoporfin continuously through a peripheral vein, using a non‑thermal laser at a wavelength of 689 nm, for the treatment of choroidal neovascularisation
546.15
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
88.50
Subgroup 10—Operations for osteomyelitis
43500
Operation on phalanx (for acute osteomyelitis) (H) (Anaes.)
123.35
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.)
204.70
43506
Operation on humerus or femur (for acute osteomyelitis)—one bone (H) (Anaes.) (Assist.)
356.35
43509
Operation on spine or pelvic bones (for acute osteomyelitis)—one bone (H) (Anaes.) (Assist.)
356.35
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.)
356.35
43515
Operation on humerus or femur (for chronic osteomyelitis)—one bone (Anaes.) (Assist.)
356.35
43518
Operation on spine or pelvic bones (for chronic osteomyelitis)—one bone (H) (Anaes.) (Assist.)
587.60
43521
Operation on skull (for chronic osteomyelitis) (H) (Anaes.) (Assist.)
464.50
43524
Operation on any combination of adjoining bones, being bones referred to in item 43515, 43518 or 43521 (for chronic osteomyelitis) (Anaes.) (Assist.)
587.60
Subgroup 11—Paediatric
43801
Intestinal malrotation with or without volvulus, laparotomy for, not involving bowel resection (H) (Anaes.) (Assist.)
957.30
43804
Intestinal malrotation with or without volvulus, laparotomy for, with bowel resection and anastomosis, with or without formation of stoma (H) (Anaes.) (Assist.)
1 019.25
43807
Duodenal atresia or stenosis, duodenoduodenostomy or duodenojejunostomy for (H) (Anaes.) (Assist.)
1 112.00
43810
Jejunal atresia, bowel resection and anastomosis for, with or without tapering (H) (Anaes.) (Assist.)
1 297.35
43813
Meconium ileus, laparotomy for, complicated by one or more of associated volvulus, atresia, intestinal perforation with or without meconium peritonitis (H) (Anaes.) (Assist.)
1 297.35
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.)
1 204.60
43819
Hirschsprung’s disease, laparotomy for, with or without frozen section biopsies and formation of stoma (H) (Anaes.) (Assist.)
972.95
43822
Anorectal malformation, laparotomy and colostomy for (H) (Anaes.) (Assist.)
972.95
43825
Neonatal alimentary obstruction, laparotomy for, other than a service to which another item in this Subgroup applies (H) (Anaes.) (Assist.)
1 112.00
43828
Acute neonatal necrotising enterocolitis, laparotomy for, with resection, including any anastomoses or stoma formation (H) (Anaes.) (Assist.)
1 228.55
43831
Acute neonatal necrotising enterocolitis, if no definitive procedure is possible, laparotomy for (H) (Anaes.) (Assist.)
957.30
43834
Bowel resection for necrotising enterocolitis stricture or strictures, including any anastomoses or stoma formation (H) (Anaes.) (Assist.)
1 112.00
43837
Congenital diaphragmatic hernia, repair by thoracic or abdominal approach, with diagnosis confirmed in the first 24 hours of life (H) (Anaes.) (Assist.)
1 389.90
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.)
1 204.60
43843
Oesophageal atresia (with or without repair of tracheo‑oesophageal fistula), complete correction of, other than a service to which item 43846 applies (H) (Anaes.) (Assist.)
1 853.35
43846
Oesophageal atresia (with or without repair of tracheo‑oesophageal fistula), complete correction of, in infant of birth weight less than 1 500 gms (H) (Anaes.) (Assist.)
1 992.30
43849
Oesophageal atresia, gastrostomy for (H) (Anaes.) (Assist.)
509.65
43852
Oesophageal atresia, thoracotomy for, and division of tracheo‑oesophageal fistula without anastomosis (Anaes.) (Assist.)
1 621.55
43855
Oesophageal atresia, delayed primary anastomosis for (H) (Anaes.) (Assist.)
1 714.35
43858
Oesophageal atresia, cervical oesophagostomy for (Anaes.) (Assist.)
602.25
43861
Congenital cystadenomatoid malformation or congenital lobar emphysema, thoracotomy and lung resection for (H) (Anaes.) (Assist.)
1 668.05
43864
Gastroschisis, operation for (H) (Anaes.) (Assist.)
1 251.05
43867
Gastroschisis, secondary operation for, with removal of silo and closure of abdominal wall (H) (Anaes.) (Assist.)
695.00
43870
Exomphalos containing small bowel only, operation for (H) (Anaes.) (Assist.)
972.95
43873
Exomphalos containing small bowel and other viscera, operation for (H) (Anaes.) (Assist.)
1 297.35
43876
Sacrococcygeal teratoma, excision of, by posterior approach (H) (Anaes.) (Assist.)
1 112.00
43879
Sacrococcygeal teratoma, excision of, by combined posterior and abdominal approach (H) (Anaes.) (Assist.)
1 297.35
43882
Cloacal exstrophy, operation for (Anaes.) (Assist.)
1 668.05
43900
Tracheo‑oesophageal fistula without atresia, division and repair of (H) (Anaes.) (Assist.)
1 112.00
43903
Oesophageal atresia or corrosive oesophageal stricture, oesophageal replacement for, utilising gastric tube, jejunum or colon (H) (Anaes.) (Assist.)
1 853.35
43906
Oesophagus, resection of congenital, anastomic or corrosive stricture and anastomosis, other than a service to which item 43903 applies (H) (Anaes.) (Assist.)
1 621.55
43909
Tracheomalacia, aortopexy for (H) (Anaes.) (Assist.)
1 621.55
43912
Thoracotomy and excision of one or more of bronchogenic or enterogenous cyst or mediastinal teratoma (H) (Anaes.) (Assist.)
1 532.00
43915
Eventration, plication of diaphragm for (Anaes.) (Assist.)
1 158.30
43930
Hypertrophic pyloric stenosis, pyloromyotomy for (H) (Anaes.) (Assist.)
445.40
43933
Idiopathic intussusception, laparotomy and manipulative reduction of (H) (Anaes.) (Assist.)
521.40
43936
Intussusception, laparotomy and resection with anastomosis (H) (Anaes.) (Assist.)
972.95
43939
Ventral hernia following neonatal closure of exomphalos or gastroschisis, repair of (H) (Anaes.) (Assist.)
741.30
43942
Abdominal wall vitello intestinal remnant, excision of (Anaes.)
231.70
43945
Patent vitello intestinal duct, excision of (H) (Anaes.) (Assist.)
972.95
43948
Umbilical granuloma, excision of, under general anaesthesia (Anaes.)
139.10
43951
Gastro‑oesophageal reflux with or without hiatus hernia, laparotomy and fundoplication for, without gastrostomy (H) (Anaes.) (Assist.)
871.30
43954
Gastro‑oesophageal reflux with or without hiatus hernia, laparotomy and fundoplication for, with gastrostomy (H) (Anaes.) (Assist.)
1 065.75
43957
Gastro‑oesophageal reflux, laparotomy and fundoplication for, with or without hiatus hernia, in child with neurological disease, with gastrostomy (H) (Anaes.) (Assist.)
1 158.30
43960
Anorectal malformation, perineal anoplasty of (H) (Anaes.) (Assist.)
407.50
43963
Anorectal malformation, posterior sagittal anorectoplasty of (H) (Anaes.) (Assist.)
1 621.55
43966
Anorectal malformation, posterior sagittal anorectoplasty of, with laparotomy (H) (Anaes.) (Assist.)
1 853.35
43969
Persistent cloaca, total correction of, with genital repair using posterior sagittal approach, with or without laparotomy (H) (Anaes.) (Assist.)
2 548.35
43972
Choledochal cyst, resection of, with one duct anastomosis (H) (Anaes.) (Assist.)
1 853.35
43975
Choledochal cyst, resection of, with 2 duct anastomoses (H) (Anaes.) (Assist.)
2 177.70
43978
Biliary atresia, portoenterostomy for (H) (Anaes.) (Assist.)
1 853.35
43981
Nephroblastoma, neuroblastoma or other malignant tumour, laparotomy (exploratory), including associated biopsies, if no other intra‑abdominal procedure is performed (H) (Anaes.) (Assist.)
509.65
43984
Nephroblastoma, radical nephrectomy for (H) (Anaes.) (Assist.)
1 297.35
43987
Neuroblastoma, radical excision of (H) (Anaes.) (Assist.)
1 436.40
43990
Hirschsprung’s disease, definitive resection with pull‑through anastomosis, with or without frozen section biopsies, when aganglionic segment extends to sigmoid colon (H) (Anaes.) (Assist.)
1 760.75
43993
Hirschsprung’s disease, definitive resection with pull‑through anastomosis, with or without frozen section biopsies, when aganglionic segment extends into descending or transverse colon with or without resiting of stoma (Anaes.) (Assist.)
1 899.65
43996
Hirschsprung’s disease, total colectomy for total colonic aganglionosis with ileoanal pull‑through, with or without side to side ileocolonic anastomosis (Anaes.) (Assist.)
2 131.35
43999
Hirschsprung’s disease, anal sphincterotomy as an independent procedure for (H) (Anaes.) (Assist.)
266.55
44102
Rectum, examination of, under general anaesthesia with full thickness biopsy or removal of polyp or similar lesion (H) (Anaes.) (Assist.)
256.95
44105
Rectal prolapse, submucosal or perirectal injection for, under general anaesthesia (Anaes.)
45.10
44108
Inguinal hernia repair at age less than 3 months (H) (Anaes.) (Assist.)
491.45
44111
Obstructed or strangulated inguinal hernia, repair of, at age less than 3 months, including orchidopexy when performed (Anaes.) (Assist.)
575.65
44114
Inguinal hernia repair at age less than 3 months when orchidopexy also required (H) (Anaes.) (Assist.)
575.65
44130
Lymphadenectomy, for atypical mycobacterial infection or other granulomatous disease (Anaes.) (Assist.)
463.30
44133
Torticollis, open division of sternomastoid muscle for (H) (Anaes.) (Assist.)
367.75
44136
Ingrown toe nail, operation for, under general anaesthesia (Anaes.)
169.50
Subdivision F—Subgroups 12 and 13
2.44.18 Meaning of amount under clause 2.44.18
In item 44376:
amount under clause 2.44.18 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.
2.44.19 Meaning of maxilla
In items 45720 to 45752, maxilla includes the zygoma.
Group T8—Surgical operations
Item
Description
Fee ($)
Subgroup 12—Amputations
44325
Hand, midcarpal or transmetacarpal, amputation of (Anaes.) (Assist.)
295.70
44328
Hand, forearm or through arm, amputation of (H) (Anaes.) (Assist.)
356.35
44331
Amputation at shoulder (H) (Anaes.) (Assist.)
587.60
44334
Interscapulothoracic amputation (Anaes.) (Assist.)
1 194.25
44338
one digit of foot, amputation of (Anaes.)
144.00
44342
2 digits of one foot, amputation of (H) (Anaes.)
219.95
44346
3 digits of one foot, amputation of (H) (Anaes.) (Assist.)
254.00
44350
4 digits of one foot, amputation of (H) (Anaes.) (Assist.)
288.20
44354
5 digits of one foot, amputation of (H) (Anaes.) (Assist.)
329.80
44358
Toe, including metatarsal or part of metatarsal—each toe, amputation of (H) (Anaes.)
183.90
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 after‑care (H) (Anaes.) (Assist.)
263.95
44361
Foot at ankle (Syme, Pirogoff types), amputation of (H) (Anaes.) (Assist.)
356.35
44364
Foot, midtarsal or transmetatarsal, amputation of (H) (Anaes.) (Assist.)
295.70
44367
Amputation through thigh, at knee or below knee (H) (Anaes.) (Assist.)
521.95
44370
Amputation at hip (H) (Anaes.) (Assist.)
720.20
44373
Hindquarter, amputation of (Anaes.) (Assist.)
1 478.40
44376
Amputation stump, re‑amputation of, to provide adequate skin and muscle cover (Anaes.) (Assist.)
Amount under clause 2.44.18
Subgroup 13—Plastic and reconstructive surgery
45000
Single stage local muscle flap repair, on eyelid, nose, lip, neck, hand, thumb, finger or genitals (Anaes.)
541.35
45003
Single stage local myocutaneous flap repair to one defect, simple and small (Anaes.)
601.65
45006
Single stage large myocutaneous flap repair to one defect (pectoralis major, latissimus dorsi, or similar large muscle) (H) (Anaes.) (Assist.)
1 037.65
45009
Single stage local muscle flap repair to one defect, simple and small (H) (Anaes.) (Assist.)
379.05
45012
Single stage large muscle flap repair to one defect (pectoralis major, gastrocnemius, gracilis or similar large muscle) (H) (Anaes.) (Assist.)
635.00
45015
Muscle or myocutaneous flap, delay of (H) (Anaes.)
300.75
45018
Dermis, dermofat or fascia graft (excluding transfer of fat by injection) (Anaes.) (Assist.)
473.65
45019
Full face chemical peel for severely sun‑damaged skin, if it can be demonstrated that the damage affects 75% of the facial skin surface area involving photodamage (dermatoheliosis) typically consisting of solar keratoses, solar lentigines, freckling, yellowing and leathering of the skin, when at least medium depth peeling agents are used, performed in the operating theatre of a hospital by a specialist in the practice of his or her specialty (H) (Anaes.)
396.70
45020
Full face chemical peel for severe chloasma or melasma refractory to all other treatments, if it can be demonstrated that the chloasma or melasma affects 75% of the facial skin surface area involving diffuse pigmentation visible at a distance of 4 metres, when at least medium depth peeling agents are used, performed in the operating theatre of a hospital by a specialist in the practice of his or her specialty—one session only in a 12 month period (Anaes.)
396.70
45021
Abrasive therapy for severely disfiguring scarring resulting from trauma, burns or acne—limited to one aesthetic area (Anaes.)
177.35
45024
Abrasive therapy for severely disfiguring scarring resulting from trauma, burns or acne—more than one aesthetic area (Anaes.)
398.55
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.)
177.35
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.)
398.55
45027
Angioma, cauterisation of or injection into, if undertaken in the operating theatre of a hospital (Anaes.)
120.35
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.)
129.25
45033
Angioma (haemangioma or lymphangioma or both), large or involving deeper tissue including facial muscle or breast, excision and suture of (Anaes.)
240.70
45035
Angioma (haemangioma or lymphangioma or both) large and deep, involving muscles or nerves, excision of (H) (Anaes.) (Assist.)
702.05
45036
Angioma (haemangioma or lymphangioma or both) of neck, deep, excision of (H) (Anaes.) (Assist.)
1 128.05
45039
Arteriovenous malformation (3 cm or less) of superficial tissue, excision of (Anaes.)
240.70
45042
Arteriovenous malformation, (greater than 3 cm), excision of (Anaes.) (Assist.)
308.40
45045
Arteriovenous malformation on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals, excision of (Anaes.)
308.40
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.)
774.55
45051
Contour reconstruction for pathological deformity, insertion of foreign implant (non biological but excluding injection of liquid or semisolid material) by open operation (H) (Anaes.) (Assist.)
473.75
45054
Limb or chest, decompression escharotomy of (including all incisions), for acute compartment syndrome secondary to burn (H) (Anaes.) (Assist.)
246.10
45200
Single stage local flap, if indicated to repair one defect, simple and small, excluding flap for male pattern baldness and excluding H‑flap or double advancement flap (Anaes.)
284.35
45203
Single stage local flap, if indicated to repair one defect, complicated or large, excluding flap for male pattern baldness and excluding H‑flap or double advancement flap (Anaes.) (Assist.)
406.05
45206
Single stage local flap if indicated to repair one defect, on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals and excluding H‑flap or double advancement flap (Anaes.)
383.55
45207
H‑flap or double advancement flap if indicated to repair one defect, on eyelid, eyebrow or forehead (Anaes.)
383.55
45209
Direct flap repair (cross arm, abdominal or similar), first stage (Anaes.) (Assist.)
473.75
45212
Direct flap repair (cross arm, abdominal or similar), second stage (Anaes.)
235.05
45215
Direct flap repair, cross leg, first stage (H) (Anaes.) (Assist.)
1 014.05
45218
Direct flap repair, cross leg, second stage (H) (Anaes.) (Assist.)
454.85
45221
Direct flap repair, small (cross finger or similar), first stage (Anaes.)
261.55
45224
Direct flap repair, small (cross finger or similar), second stage (Anaes.)
117.55
45227
Indirect flap or tubed pedicle, formation of (Anaes.) (Assist.)
445.40
45230
Direct or indirect flap or tubed pedicle, delay of (Anaes.)
222.75
45233
Indirect flap or tubed pedicle, preparation of intermediate or final site and attachment to the site (Anaes.) (Assist.)
473.75
45236
Indirect flap or tubed pedicle, spreading of pedicle, as a separate procedure (H) (Anaes.)
371.50
45239
Direct, indirect or local flap, revision of, by incision and suture, other than a service to which item 45240 applies (Anaes.)
261.55
45240
Direct, indirect or local flap, revision of, by liposuction, other than a service to which item 45239, 45497, 45498 or 45499 applies (Anaes.)
261.55
45400
Free grafting (split skin) of a granulating area, small (Anaes.)
204.70
45403
Free grafting (split skin) of a granulating area, extensive (Anaes.) (Assist.)
407.50
45406
Free grafting (split skin) to burns, including excision of burnt tissue—involving not more than 3% of total body surface (Anaes.) (Assist.)
451.10
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.)
601.65
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.)
827.30
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.)
902.30
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.)
977.55
45439
Free grafting (split skin) to one defect, including elective dissection, small (Anaes.)
284.35
45442
Free grafting (split skin) to one defect, including elective dissection, extensive (Anaes.) (Assist.)
586.50
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.)
556.60
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.)
376.00
45451
Free grafting (full thickness) to one defect, excluding grafts for male pattern baldness (Anaes.) (Assist.)
473.75
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.)
1 253.30
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.)
893.25
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, co‑surgeon (H) (Assist.)
674.05
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.)
1 913.10
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.)
1 363.00
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, co‑surgeon (H) (Assist.)
1 027.95
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.)
1 832.65
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, co‑surgeon (H) (Assist.)
1 382.70
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.)
2 303.65
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, co‑surgeon (H) (Assist.)
1 737.60
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.)
2 773.30
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, co‑surgeon (H) (Assist.)
2 092.45
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.)
3 243.00
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, co‑surgeon (H) (Assist.)
2 446.05
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.)
3 712.60
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, co‑surgeon (H) (Assist.)
2 801.10
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.)
4 229.95
45484
Free grafting (split skin) to burns, including excision of burnt tissue, involving 80% or more of total body surface—conjoint surgery, co‑surgeon (H) (Assist.)
3 191.50
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.)
527.70
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.)
451.10
45487
Free grafting (split skin) to burns, including excision of burnt tissue—whole of toe (Anaes.) (Assist.)
406.05
45488
Free grafting (split skin) to burns, including excision of burnt tissue—the whole of one digit of the hand (H) (Anaes.) (Assist.)
451.10
45489
Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 2 digits of the hand (H) (Anaes.) (Assist.)
676.80
45490
Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 3 digits of the hand (H) (Anaes.) (Assist.)
902.50
45491
Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 4 digits of the hand (H) (Anaes.) (Assist.)
1 128.05
45492
Free grafting (split skin) to burns, including excision of burnt tissue—the whole of 5 digits of the hand (H) (Anaes.) (Assist.)
1 353.60
45493
Free grafting (split skin) to burns, including excision of burnt tissue—portion of digit of hand (H) (Anaes.) (Assist.)
406.05
45494
Free grafting (split skin) to burns, including excision of burnt tissue—whole of face (excluding ears) (H) (Anaes.) (Assist.)
1 638.70
45496
Flap, free tissue transfer using microvascular techniques—revision of, by open operation (H) (Anaes.)
416.05
45497
Flap, free tissue transfer using microvascular techniques or any breast reconstruction—complete revision of, by liposuction (H) (Anaes.)
324.95
45498
Flap, free tissue transfer using microvascular techniques or any breast reconstruction—staged revision of, by liposuction (first stage) (H) (Anaes.)
261.55
45499
Flap, free tissue transfer using microvascular techniques or any breast reconstruction—staged revision of, by liposuction (second stage) (H) (Anaes.)
195.00
45500
Microvascular repair using microsurgical techniques, with restoration of continuity of artery or vein of distal extremity or digit (H) (Anaes.) (Assist.)
1 090.35
45501
Microvascular anastomosis of artery using microsurgical techniques, for re‑implantation of limb or digit (H) (Anaes.) (Assist.)
1 774.70
45502
Microvascular anastomosis of vein using microsurgical techniques, for re‑implantation of limb or digit (H) (Anaes.) (Assist.)
1 774.70
45503
Micro‑arterial or micro‑venous graft using microsurgical techniques (H) (Anaes.) (Assist.)
2 030.35
45504
Microvascular anastomosis of artery using microsurgical techniques, for free transfer of tissue including setting in of free flap (H) (Anaes.) (Assist.)
1 774.70
45505
Microvascular anastomosis of vein using microsurgical techniques, for free transfer of tissue including setting in of free flap (H) (Anaes.) (Assist.)
1 774.70
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 his or her specialty (Anaes.)
219.95
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 his or her specialty (Anaes.)
295.70
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 his or her specialty (Anaes.)
186.50
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 his or her speciality (Anaes.)
225.70
45519
Extensive burn scars of skin (more than 1% of body surface area), excision of, for correction of scar contracture (H) (Anaes.) (Assist.)
429.05
45520
Reduction mammaplasty (unilateral) with surgical repositioning of nipple (H) (Anaes.) (Assist.)
900.45
45522
Reduction mammaplasty (unilateral) without surgical repositioning of nipple, excluding the treatment of gynaecomastia (H) (Anaes.) (Assist.)
631.75
45524
Mammaplasty, augmentation, for significant breast asymmetry if the augmentation is limited to one breast (H) (Anaes.) (Assist.)
741.65
45527
Mammaplasty, augmentation, (unilateral), following mastectomy (H) (Anaes.) (Assist.)
741.65
45528
Mammaplasty, augmentation, bilateral, other than a service to which item 45527 applies, if it can be demonstrated that surgery is indicated because of malformation of breast tissue (excluding hypomastia), or disease or trauma of the breast (other than trauma resulting from previous elective cosmetic surgery) (H) (Anaes.) (Assist.)
1 112.35
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, 30174 or 30177 applies (H) (Anaes.) (Assist.)
1 099.40
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.)
1 245.10
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.)
457.85
45539
Breast reconstruction (unilateral), following mastectomy, using tissue expansion—insertion of tissue expansion unit and all attendances for subsequent expansion injections (H) (Anaes.) (Assist.)
1 071.20
45542
Breast reconstruction (unilateral), following mastectomy, using tissue expansion—removal of tissue expansion unit and insertion of permanent prosthesis (H) (Anaes.) (Assist.)
613.40
45545
Nipple or areola or both, reconstruction of, by any surgical technique (Anaes.) (Assist.)
622.55
45546
Nipple or areola or both, intradermal colouration of, following breast reconstruction after mastectomy or for congenital absence of nipple
197.85
45548
Breast prosthesis, removal of, as an independent procedure (Anaes.)
276.80
45551
Breast prosthesis, removal of, with excision of fibrous capsule (H) (Anaes.) (Assist.)
443.70
45552
Breast prosthesis, removal of, with excision of fibrous capsule and replacement of prosthesis (Anaes.) (Assist.)
638.65
45553
Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (such as rupture, migration of prosthetic material, or capsule formation) (Anaes.) (Assist.)
638.65
45554
Breast prosthesis, removal and replacement with another prosthesis, following medical complications (such as rupture, migration of prosthetic material, or capsule formation), if new pocket is formed, including excision of fibrous capsule (Anaes.) (Assist.)
699.45
45555
Silicone breast prosthesis, removal of and replacement with prosthesis other than silicone gel prosthesis (H) (Anaes.) (Assist.)
638.65
45556
Breast ptosis, correction of (unilateral), to match the position of the contralateral breast (H) (Anaes.) (Assist.)
766.05
45557
Breast ptosis, correction by mastopexy of (unilateral), following pregnancy and lactation, when performed not less than one year, and not more than 7 years, after the end of the most recent pregnancy of the patient, and if it can be demonstrated that the nipple is inferior to the infra‑mammary groove, other than a service associated with a service to which item 45522 applies (H) (Anaes.) (Assist.)
766.05
45558
Breast ptosis, correction by mastopexy of (bilateral), following pregnancy and lactation, when performed not less than one year, and not more than 7 years, after the end of the most recent pregnancy of the patient, and if it can be demonstrated that the nipple is inferior to the infra‑mammary groove, other than a service associated with a service to which item 45522 applies (H) (Anaes.) (Assist.)
1 148.95
45559
Tuberous, tubular or constricted breast, if it can be demonstrated, correction of by simultaneous mastopexy and augmentation of (unilateral) (Anaes.) (Assist.)
1 136.80
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.)
473.65
45561
Microvascular anastomosis of artery or vein using microsurgical techniques, for supercharging of pedicled flaps (H) (Anaes.) (Assist.)
1 774.70
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.)
1 099.40
45563
Neurovascular island flap, including direct repair of secondary cutaneous defect if performed, excluding flap for male pattern baldness (Anaes.) (Assist.)
1 099.40
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, 30174, 30177, 45501, 45502, 45504, 45505 or 45562 applies—conjoint surgery, principal specialist surgeon (H) (Anaes.) (Assist.)
2 546.30
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, 30174, 30177, 45501, 45502, 45504, 45505 or 45562 applies—conjoint surgery, conjoint specialist surgeon (H) (Assist.)
1 909.80
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.)
1 071.20
45568
Tissue expander, removal of, with complete excision of fibrous capsule (H) (Anaes.) (Assist.)
443.70
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.)
677.60
45570
Closure of abdomen, repair of musculoaponeurotic layer, being a service associated with item 45569 (Anaes.) (Assist.)
914.95
45572
Intra‑operative 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.)
291.70
45575
Facial nerve paralysis, free fascia graft for (Anaes.) (Assist.)
720.20
45578
Facial nerve paralysis, muscle transfer for (H) (Anaes.) (Assist.)
834.05
45581
Facial nerve palsy, excision of tissue for (Anaes.)
276.80
45584
Liposuction (suction assisted lipolysis) to one regional area (thigh, buttock, or similar), for treatment of post‑traumatic pseudolipoma (Anaes.)
631.75
45585
Liposuction (suction assisted lipolysis) to one regional area, other than a service associated with a service to which item 31525 applies, if it can be demonstrated that the treatment is for Barraquer‑Simon’s syndrome (pathological lipodystrophy of hips, buttocks, thighs, knees or lower legs), lymphoedema or macrodystrophia lipomatosa (Anaes.)
631.75
45586
Liposuction (suction assisted lipolysis) for reduction of a buffalo hump, if it can be demonstrated that the buffalo hump is secondary to an endocrine disorder or pharmacological treatment of a medical condition (H) (Anaes.)
631.75
45587
Meloplasty for correction of facial asymmetry due to soft tissue abnormality if the meloplasty is limited to one side of the face (Anaes.) (Assist.)
890.85
45588
Meloplasty (excluding browlifts and chinlift platysmaplasties), bilateral, if it can be demonstrated that surgery is indicated because of congenital conditions, disease or trauma (other than trauma resulting from previous elective cosmetic surgery) (H) (Anaes.) (Assist.)
1 336.40
45590
Orbital cavity, reconstruction of a wall or floor, with or without foreign implant (H) (Anaes.) (Assist.)
483.25
45593
Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (H) (Anaes.) (Assist.)
567.65
45596
Maxilla, total resection of (H) (Anaes.) (Assist.)
900.45
45597
Maxilla, total resection of both maxillae (H) (Anaes.) (Assist.)
1 205.40
45599
Mandible, total resection of both sides, including condylectomies, if performed (Anaes.) (Assist.)
936.55
45602
Mandible, including lower border, or maxilla, sub‑total resection of (H) (Anaes.) (Assist.)
699.45
45605
Mandible or maxilla, segmental resection of, for tumours or cysts (H) (Anaes.) (Assist.)
587.60
45608
Mandible, hemi‑mandibular reconstruction with bone graft, other than a service associated with a service to which item 45599 applies (H) (Anaes.) (Assist.)
827.30
45611
Mandible, condylectomy (H) (Anaes.) (Assist.)
473.75
45614
Eyelid, whole thickness reconstruction of, other than by direct suture only (Anaes.) (Assist.)
587.60
45617
Upper eyelid, reduction of, for skin redundancy obscuring vision (as evidenced by upper eyelid skin resting on lashes on straight ahead gaze), herniation of orbital fat in exophthalmos, facial nerve palsy or post‑traumatic scarring, or the restoration of symmetry of contralateral upper eyelid in respect of one of these conditions (Anaes.)
235.05
45620
Lower eyelid, reduction of, for herniation of orbital fat in exophthalmos, facial nerve palsy or post‑traumatic scarring, or, in respect of one of these conditions, the restoration of symmetry of the contralateral lower eyelid (Anaes.)
326.05
45623
Ptosis of eyelid (unilateral), correction of (Anaes.) (Assist.)
723.05
45624
Ptosis of eyelid, correction of, if previous ptosis surgery has been performed on that side (Anaes.) (Assist.)
937.40
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.)
187.55
45626
Ectropion or entropion, correction of (unilateral) (Anaes.)
326.05
45629
Symblepharon, grafting for (Anaes.) (Assist.)
473.75
45632
Rhinoplasty, correction of lateral or alar cartilages for correction of nasal obstruction (Anaes.)
511.95
45635
Rhinoplasty, correction of bony vault only, for correction of nasal obstruction or post‑traumatic deformity (other than deformity resulting from previous elective cosmetic surgery), or both (Anaes.)
587.60
45638
Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, for correction of nasal obstruction or post‑traumatic deformity (other than deformity resulting from previous elective cosmetic surgery), or both (H) (Anaes.)
1 014.05
45639
Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, if it can be demonstrated that there is a need for correction of significant developmental deformity (H) (Anaes.)
1 014.05
45641
Rhinoplasty involving nasal or septal cartilage graft, or nasal bone graft, or nasal bone and nasal cartilage graft, for correction of nasal obstruction or post‑traumatic deformity (other than deformity resulting from previous elective cosmetic surgery), or both (H) (Anaes.)
1 082.90
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
For correction of nasal obstruction or post‑traumatic deformity (other than deformity resulting from previous elective cosmetic surgery), or both (H) (Anaes.) (Assist.)
1 279.45
45645
Choanal atresia, repair of by puncture and dilatation (H) (Anaes.)
223.60
45646
Choanal atresia, correction by open operation with bone removal (Anaes.) (Assist.)
900.45
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.)
1 279.45
45650
Rhinoplasty, secondary revision of, for correction of nasal obstruction, post‑traumatic deformity (other than deformity resulting from previous elective cosmetic surgery) or significant developmental deformity (Anaes.)
147.80
45652
Rhinophyma, carbon dioxide laser or erbium laser excision—ablation of (Anaes.)
356.35
45653
Rhinophyma, shaving of (Anaes.)
356.35
45656
Composite graft (chondro‑cutaneous or chondro‑mucosal) to nose, ear or eyelid (Anaes.) (Assist.)
502.25
45659
Lop ear, bat ear or similar deformity, correction of (Anaes.)
521.25
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 post‑traumatic loss of entire or substantial portion of pinna (first stage)—performed by a specialist in the practice of his or her specialty (H) (Anaes.) (Assist.)
2 878.75
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 his or her specialty (H) (Anaes.) (Assist.)
1 279.45
45662
Congenital atresia, reconstruction of external auditory canal (H) (Anaes.) (Assist.)
701.30
45665
Lip, eyelid or ear, full thickness wedge excision of, with repair by direct sutures (Anaes.)
326.05
45668
Vermilionectomy, by surgical excision (Anaes.)
326.05
45669
Vermilionectomy, using carbon dioxide laser or erbium laser excision—ablation (Anaes.)
326.05
45671
Lip or eyelid reconstruction using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)
834.05
45674
Lip or eyelid reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)
242.55
45675
Macrocheilia or macroglossia, operation for (H) (Anaes.) (Assist.)
483.25
45676
Macrostomia, operation for (H) (Anaes.) (Assist.)
575.30
45677
Cleft lip, unilateral—primary repair, one stage, without anterior palate repair (H) (Anaes.) (Assist.)
541.35
45680
Cleft lip, unilateral—primary repair, one stage, with anterior palate repair (H) (Anaes.) (Assist.)
676.80
45683
Cleft lip, bilateral—primary repair, one stage, without anterior palate repair (H) (Anaes.) (Assist.)
751.85
45686
Cleft lip, bilateral—primary repair, one stage, with anterior palate repair (H) (Anaes.) (Assist.)
887.50
45689
Cleft lip, lip adhesion procedure, unilateral or bilateral (H) (Anaes.) (Assist.)
261.75
45692
Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)
300.75
45695
Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (H) (Anaes.) (Assist.)
488.75
45698
Cleft lip, primary columella lengthening procedure, bilateral (H) (Anaes.)
458.75
45701
Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (H) (Anaes.) (Assist.)
827.30
45704
Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)
300.75
45707
Cleft palate, primary repair (H) (Anaes.) (Assist.)
781.95
45710
Cleft palate, secondary repair, closure of fistula using local flaps (H) (Anaes.)
488.75
45713
Cleft palate, secondary repair, lengthening procedure (H) (Anaes.) (Assist.)
556.60
45714
Oro‑nasal fistula, plastic closure of, including services to which item 45200, 45203 or 45239 applies (H) (Anaes.) (Assist.)
781.95
45716
Velo‑pharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (H) (Anaes.)
781.95
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.)
966.80
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.)
1 090.35
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.)
1 232.05
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.)
1 383.65
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.)
1 402.70
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.)
1 579.20
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.)
1 611.05
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.)
1 812.40
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.)
1 772.30
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.)
1 992.70
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.)
1 933.55
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.)
2 165.75
45753
Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar‑Maxillary), 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.)
2 178.60
45754
Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar‑Maxillary), 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.)
2 611.60
45755
Temporo‑mandibular partial or total meniscectomy (Anaes.) (Assist.)
367.75
45758
Temporo‑mandibular joint, arthroplasty (H) (Anaes.) (Assist.)
658.05
45761
Genioplasty, including transposition of nerves and vessels and bone grafts taken from the same site (H) (Anaes.) (Assist.)
748.65
45767
Hypertelorism, correction of, intra‑cranial (Anaes.) (Assist.)
2 511.65
45770
Hypertelorism, correction of, sub‑cranial (H) (Anaes.) (Assist.)
1 923.90
45773
Treacher Collins Syndrome, periorbital correction of, with rib and iliac bone grafts (Anaes.) (Assist.)
1 753.40
45776
Orbital dystopia (unilateral), correction of, with total repositioning of one orbit, intra‑cranial (H) (Anaes.) (Assist.)
1 753.40
45779
Orbital dystopia (unilateral), correction of, with total repositioning of one orbit, extra‑cranial (H) (Anaes.) (Assist.)
1 289.15
45782
Fronto‑orbital advancement, unilateral (Anaes.) (Assist.)
985.70
45785
Cranial vault reconstruction for oxycephaly, brachycephaly, turricephaly or similar condition—(bilateral fronto‑orbital advancement) (H) (Anaes.) (Assist.)
1 668.10
45788
Glenoid fossa, zygomatic arch and temporal bone, reconstruction of, (Obwegeser technique) (H) (Anaes.) (Assist.)
1 649.10
45791
Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (H) (Anaes.) (Assist.)
890.85
45794
Osseo‑integration procedure—extra‑oral, implantation of titanium fixture, not for implantable bone conduction hearing system device (Anaes.)
503.85
45797
Osseo‑integration procedure, fixation of transcutaneous abutment, not for implantable bone conduction hearing system device (Anaes.)
186.50
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.)
29.45
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.)
126.90
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.)
326.05
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.)
172.50
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.)
246.50
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.)
371.50
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.)
502.25
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.)
587.60
45815
Operation on mandible or maxilla (other than alveolar margins) for chronic osteomyelitis—one bone or in combination with adjoining bones (Anaes.) (Assist.)
356.35
45817
Operation on skull for osteomyelitis (Anaes.) (Assist.)
464.50
45819
Operation on any combination of adjoining bones in the oral and maxillofacial region, being bones referred to in item 45817 (Anaes.) (Assist.)
587.55
45821
Bone growth stimulator in the oral and maxillofacial region, insertion of (Anaes.) (Assist.)
380.80
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 (Anaes.)
108.90
45825
Mandibular or palatal exostosis, excision of (Anaes.) (Assist.)
338.35
45827
Mylohyoid ridge, reduction of (Anaes.) (Assist.)
323.40
45829
Maxillary tuberosity, reduction of (Anaes.)
246.70
45831
Papillary hyperplasia of the palate, removal of—less than 5 lesions (Anaes.) (Assist.)
323.40
45833
Papillary hyperplasia of the palate, removal of—5 to 20 lesions (Anaes.) (Assist.)
406.05
45835
Papillary hyperplasia of the palate, removal of—more than 20 lesions (Anaes.) (Assist.)
503.85
45837
Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed—unilateral or bilateral (Anaes.) (Assist.)
586.50
45839
Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed—unilateral (Anaes.) (Assist.)
586.50
45841
Alveolar ridge augmentation with bone or alloplast or both—unilateral (Anaes.) (Assist.)
473.65
45843
Alveolar ridge augmentation—unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region (Anaes.) (Assist.)
290.50
45845
Osseo‑integration procedure—intra‑oral 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.)
503.85
45847
Osseo‑integration procedure—fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)
186.50
45849
Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes.) (Assist.)
580.90
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 (Anaes.)
142.95
45853
Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)
890.85
45855
Temporomandibular joint, arthroscopy of, with or without biopsy, other than a service associated with another arthroscopic procedure of that joint (Anaes.) (Assist.)
408.70
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.)
653.80
45859
Temporomandibular joint, arthrotomy of, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)
329.60
45861
Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)
872.30
45863
Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)
967.00
45865
Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (Anaes.) (Assist.)
290.50
45867
Temporomandibular joint, synovectomy of, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)
312.30
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.)
1 188.20
45871
Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)
1 338.45
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.)
1 504.05
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.)
470.70
45877
Temporomandibular joint, arthrodesis of, with synovectomy if performed, other than a service to which another item in this Subgroup applies (Anaes.) (Assist.)
470.70
45879
Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)
312.30
45882
Treatment of a premalignant lesion of the oral mucosa using cryotherapy, diathermy or carbon dioxide laser
43.00
45885
Ligation of a facial, mandibular or lingual artery or vein, or artery and vein
443.70
45888
Removal of a deep foreign body using interventional imaging techniques
413.55
45891
Repair to one defect using temporalis muscle by a single stage local flap
602.45
45894
Free grafting of a granulating area (mucosa or split skin)
204.70
45897
Grafting of, including plastic closure of associated oro‑nasal fistulae and ridge augmentation, a unilateral alveolar cleft (congenital)
1 069.10
45900
Fixation of the mandible by intermaxillary wiring, excluding wiring for obesity
241.15
45939
Cryosurgery of the peripheral branches of the trigeminal nerve for pain relief
447.10
45945
Treatment of a dislocation of the mandible requiring open reduction
118.70
45975
Treatment of a fracture of the unilateral or bilateral maxilla, not requiring splinting
129.20
45978
Treatment of a fracture of the mandible, not requiring splinting
157.85
45981
Treatment of the zygomatic bone, not requiring surgical reduction
85.65
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
616.65
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
616.65
45990
Treatment of a complicated fracture of the maxilla including viscera, blood vessels or nerves, requiring open reduction involving the use of a plate
842.25
45993
Treatment of a complicated fracture of the mandible involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate
842.25
45996
Treatment of a closed fracture of the mandible involving a joint surface
238.80
Subdivision G—Subgroup 14
2.44.20 Items 46300 to 46534 apply only in certain circumstances
Items 46300 to 46534 apply only to a service provided in the course of an operation on a hand or hands.
Group T8—Surgical operations
Item
Description
Fee ($)
Subgroup 14—Hand surgery
46300
Interphalangeal joint or metacarpophalangeal joint, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
338.40
46303
Carpometacarpal joint, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
376.10
46306
Interphalangeal joint or metacarpophalangeal joint—interposition arthroplasty of and including tendon transfers or realignment on the one ray (H) (Anaes.) (Assist.)
526.50
46307
Interphalangeal joint or metacarpophalangeal joint—volar plate arthroplasty for traumatic deformity including tendon transfers or realignment on the one ray (H) (Anaes.) (Assist.)
526.50
46309
Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—one joint (H) (Anaes.) (Assist.)
526.50
46312
Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—2 joints (H) (Anaes.) (Assist.)
676.95
46315
Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—3 joints (H) (Anaes.) (Assist.)
902.55
46318
Interphalangeal joint or metacarpophalangeal joint, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment—4 joints (H) (Anaes.) (Assist.)
1 128.25
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.)
1 353.90
46324
Carpal bone replacement arthroplasty including associated tendon transfer or realignment when performed (H) (Anaes.) (Assist.)
807.35
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.)
842.50
46327
Interphalangeal joint or metacarpophalangeal joint, arthrotomy of (Anaes.)
203.15
46330
Interphalangeal joint or metacarpophalangeal joint, ligamentous or capsular repair, with or without arthrotomy (H) (Anaes.) (Assist.)
346.10
46333
Interphalangeal joint or metacarpophalangeal joint, ligamentous repair of, using free tissue graft or implant (H) (Anaes.) (Assist.)
564.05
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.)
263.30
46339
Extensor tendons or flexor tendons of hand or wrist, synovectomy of (Anaes.) (Assist.)
466.20
46342
Distal radioulnar joint or carpometacarpal joint or joints, synovectomy of (H) (Anaes.) (Assist.)
466.20
46345
Distal radioulnar joint, reconstruction or stabilisation of, including fusion, or ligamentous arthroplasty and excision of distal ulna, when performed (H) (Anaes.) (Assist.)
564.05
46348
Digit, synovectomy of flexor tendon or tendons—one digit (Anaes.)
244.45
46351
Digit, synovectomy of flexor tendon or tendons—2 digits (H) (Anaes.) (Assist.)
364.80
46354
Digit, synovectomy of flexor tendon or tendons—3 digits (H) (Anaes.) (Assist.)
488.85
46357
Digit, synovectomy of flexor tendon or tendons—4 digits (H) (Anaes.) (Assist.)
609.20
46360
Digit, synovectomy of flexor tendon or tendons—5 digits (H) (Anaes.) (Assist.)
733.35
46363
Tendon sheath of hand or wrist, open operation on, for stenosing tenovaginitis (Anaes.)
210.60
46366
Dupuytren’s contracture, subcutaneous fasciotomy for—each hand (Anaes.)
127.90
46369
Dupuytren’s contracture, palmar fasciectomy for—one hand (Anaes.)
210.60
46372
Dupuytren’s contracture, fasciectomy for, from one ray, including dissection of nerves—one hand (Anaes.) (Assist.)
427.95
46375
Dupuytren’s contracture, fasciectomy for, from 2 rays, including dissection of nerves—one hand (Anaes.) (Assist.)
507.70
46378
Dupuytren’s contracture, fasciectomy for, from 3 or more rays, including dissection of nerves—one hand (H) (Anaes.) (Assist.)
676.95
46381
Interphalangeal joint, joint capsule release when performed in conjunction with operation for Dupuytren’s contracture—each procedure (H) (Anaes.) (Assist.)
300.80
46384
Z plasty (or similar local flap procedure) when performed in conjunction with operation for Dupuytren’s contracture—one such procedure (H) (Anaes.) (Assist.)
300.80
46387
Dupuytren’s contracture, fasciectomy for, from one ray, including dissection of nerves—operation for recurrence in that ray (Anaes.) (Assist.)
620.60
46390
Dupuytren’s contracture, fasciectomy for, from 2 rays, including dissection of nerves—operation for recurrence in those rays (H) (Anaes.) (Assist.)
827.50
46393
Dupuytren’s contracture, fasciectomy for, from 3 or more rays, including dissection of nerves—operation for recurrence in those rays (H) (Anaes.) (Assist.)
959.00
46396
Phalanx or metacarpal of the hand, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (Anaes.) (Assist.)
329.60
46399
Phalanx or metacarpal of the hand, osteotomy of, with internal fixation (H) (Anaes.) (Assist.)
517.80
46402
Phalanx or metacarpal, bone grafting of, for pseudarthrosis (non‑union), including obtaining of graft material (H) (Anaes.) (Assist.)
517.80
46405
Phalanx or metacarpal, bone grafting of, for pseudarthrosis (non‑union), involving internal fixation and including obtaining of graft material (H) (Anaes.) (Assist.)
631.90
46408
Tendon, reconstruction of, by tendon graft (H) (Anaes.) (Assist.)
692.00
46411
Flexor tendon pulley, reconstruction of, by graft (H) (Anaes.) (Assist.)
406.15
46414
Artificial tendon prosthesis, insertion of, in preparation for tendon grafting (Anaes.) (Assist.)
526.40
46417
Tendon transfer for restoration of hand function, each transfer (H) (Anaes.) (Assist.)
488.85
46420
Extensor tendon of hand or wrist, primary repair of, each tendon (Anaes.)
204.60
46423
Extensor tendon of hand or wrist, secondary repair of, each tendon (Anaes.) (Assist.)
327.15
46426
Flexor tendon of hand or wrist, primary repair of, proximal to A1 pulley, each tendon (H) (Anaes.) (Assist.)
338.40
46429
Flexor tendon of hand or wrist, secondary repair of, proximal to A1 pulley, each tendon (Anaes.) (Assist.)
413.65
46432
Flexor tendon of hand, primary repair of, distal to A1 pulley, each tendon (H) (Anaes.) (Assist.)
451.35
46435
Flexor tendon of hand, secondary repair of, distal to A1 pulley, each tendon (H) (Anaes.) (Assist.)
526.50
46438
Mallet finger, closed pin fixation of (Anaes.)
135.45
46441
Mallet finger, open repair of, including pin fixation when performed (Anaes.) (Assist.)
327.15
46442
Mallet finger with intra‑articular fracture involving more than one‑third of base of terminal phalanx—open reduction (H) (Anaes.) (Assist.)
280.85
46444
Boutonniere deformity without joint contracture, reconstruction of (H) (Anaes.) (Assist.)
488.85
46447
Boutonniere deformity with joint contracture, reconstruction of (H) (Anaes.) (Assist.)
609.20
46450
Extensor tendon, tenolysis of, following tendon injury, repair or graft (H) (Anaes.)
225.70
46453
Flexor tendon, tenolysis of, following tendon injury, repair or graft (H) (Anaes.) (Assist.)
376.10
46456
Finger, percutaneous tenotomy of (Anaes.)
97.80
46459
Operation for osteomyelitis on distal phalanx (Anaes.)
188.05
46462
Operation for osteomyelitis on middle or proximal phalanx, metacarpal or carpus (Anaes.) (Assist.)
300.80
46464
Amputation of a supernumerary complete digit (Anaes.)
225.70
46465
Amputation of single digit, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.)
225.70
46468
Amputation of 2 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (H) (Anaes.) (Assist.)
394.90
46471
Amputation of 3 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.) (Assist.)
564.05
46474
Amputation of 4 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (H) (Anaes.) (Assist.)
733.35
46477
Amputation of 5 digits, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (H) (Anaes.) (Assist.)
902.55
46480
Amputation of single digit, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover, including metacarpal (Anaes.) (Assist.)
376.10
46483
Revision of amputation stump to provide adequate soft tissue cover (Anaes.) (Assist.)
300.80
46486
Nail bed, accurate reconstruction of nail bed laceration using magnification, undertaken in the operating theatre of a hospital (Anaes.)
225.70
46489
Nail bed, secondary exploration and accurate repair of nail bed deformity using magnification, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
263.30
46492
Contracture of digits of hand, flexor or extensor, correction of, involving tissues deeper than skin and subcutaneous tissue (H) (Anaes.) (Assist.)
361.05
46494
Ganglion of hand, excision of, other than a service associated with a service to which another item in this Group applies (Anaes.)
219.95
46495
Ganglion or mucous cyst of distal digit, excision of, other than a service associated with a service to which item 30106 or 30107 applies (Anaes.)
203.15
46498
Ganglion of flexor tendon sheath, excision of, other than a service associated with a service to which item 30106 or 30107 applies (Anaes.)
219.95
46500
Ganglion of dorsal wrist joint, excision of, other than a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
263.30
46501
Ganglion of volar wrist joint, excision of, other than a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
329.20
46502
Recurrent ganglion of dorsal wrist joint, excision of, other than a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
302.95
46503
Recurrent ganglion of volar wrist joint, excision of, other than a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
378.40
46504
Neurovascular island flap, for pulp innervation (Anaes.) (Assist.)
1 105.55
46507
Digit or ray, transposition or transfer of, on vascular pedicle, complete procedure (H) (Anaes.) (Assist.)
1 286.20
46510
Macrodactyly, surgical reduction of enlarged elements—each digit (H) (Anaes.) (Assist.)
351.00
46513
Digital nail of finger or thumb, removal of, other than a service to which item 46516 applies (Anaes.)
56.50
46516
Digital nail of finger or thumb, removal of, in the operating theatre of a hospital (Anaes.)
112.85
46519
Middle palmar, thenar or hypothenar spaces of hand, drainage of (excluding after‑care) (Anaes.)
141.25
46522
Flexor tendon sheath of finger or thumb—open operation and drainage for infection (H) (Anaes.) (Assist.)
421.20
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 after‑care) (Anaes.)
56.50
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.)
169.50
46531
Ingrowing nail of finger or thumb, partial resection of nail, including phenolisation but not including excision of nail bed (Anaes.)
85.15
46534
Nail plate injury or deformity, radical excision of nail germinal matrix (Anaes.)
235.50
Subdivision H—Subgroup 15
2.44.21 Limitation of item 50303
A service described in item 50303 is applicable once in any 12 month period for each limb.
Group T8—Surgical operations
Item
Description
Fee ($)
Subgroup 15—Orthopaedic
47000
Mandible, treatment of dislocation of, by closed reduction (Anaes.)
70.65
47003
Clavicle, treatment of dislocation of, by closed reduction (Anaes.)
84.80
47006
Clavicle, treatment of dislocation of, by open reduction (Anaes.)
170.25
47009
Shoulder, treatment of dislocation of, requiring general anaesthesia, other than a service to which item 47012 applies (Anaes.)
169.50
47012
Shoulder, treatment of dislocation of, requiring general anaesthesia, open reduction (H) (Anaes.) (Assist.)
338.85
47015
Shoulder, treatment of dislocation of, not requiring general anaesthesia
84.80
47018
Elbow, treatment of dislocation of, by closed reduction (Anaes.)
197.60
47021
Elbow, treatment of dislocation of, by open reduction (H) (Anaes.) (Assist.)
263.60
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.)
197.60
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.)
263.60
47030
Carpus, or carpus on radius and ulna, or carpometacarpal joint, treatment of dislocation of, by closed reduction (Anaes.)
197.60
47033
Carpus, or carpus on radius and ulna, or carpometacarpal joint, treatment of dislocation of, by open reduction (Anaes.) (Assist.)
263.60
47036
Interphalangeal joint, treatment of dislocation of, by closed reduction (Anaes.)
84.80
47039
Interphalangeal joint, treatment of dislocation of, by open reduction (Anaes.)
112.85
47042
Metacarpophalangeal joint, treatment of dislocation of, by closed reduction (Anaes.)
112.85
47045
Metacarpophalangeal joint, treatment of dislocation of, by open reduction (Anaes.)
150.75
47048
Hip, treatment of dislocation of, by closed reduction (Anaes.)
324.80
47051
Hip, treatment of dislocation of, by open reduction (H) (Anaes.) (Assist.)
432.95
47054
Knee, treatment of dislocation of, by closed reduction (Anaes.) (Assist.)
324.80
47057
Patella, treatment of dislocation of, by closed reduction (Anaes.)
127.00
47060
Patella, treatment of dislocation of, by open reduction (Anaes.)
169.50
47063
Ankle or tarsus, treatment of dislocation of, by closed reduction (Anaes.)
254.20
47066
Ankle or tarsus, treatment of dislocation of, by open reduction (H) (Anaes.) (Assist.)
338.85
47069
Toe, treatment of dislocation of, by closed reduction (Anaes.)
70.65
47072
Toe, treatment of dislocation of, by open reduction (Anaes.)
94.00
47300
Distal phalanx of finger or thumb, treatment of fracture of, by closed reduction, including percutaneous fixation, if used (Anaes.)
84.80
47303
Distal phalanx of finger or thumb, treatment of intra‑articular fracture of, by closed reduction (Anaes.)
98.90
47306
Distal phalanx of finger or thumb, treatment of fracture of, by open reduction (Anaes.)
112.85
47309
Distal phalanx of finger or thumb, treatment of intra‑articular fracture of, by open reduction (Anaes.)
141.25
47312
Middle phalanx of finger, treatment of fracture of, by closed reduction (Anaes.)
127.00
47315
Middle phalanx of finger, treatment of intra‑articular fracture of, by closed reduction (Anaes.)
145.95
47318
Middle phalanx of finger, treatment of fracture of, by open reduction (Anaes.)
169.50
47321
Middle phalanx of finger, treatment of intra‑articular fracture of, by open reduction (H) (Anaes.)
211.75
47324
Proximal phalanx of finger or thumb, treatment of fracture of, by closed reduction (Anaes.)
169.50
47327
Proximal phalanx of finger or thumb, treatment of intra‑articular fracture of, by closed reduction (Anaes.)
197.60
47330
Proximal phalanx of finger or thumb, treatment of fracture of, by open reduction (Anaes.)
226.00
47333
Proximal phalanx of finger or thumb, treatment of intra‑articular fracture of, by open reduction (H) (Anaes.) (Assist.)
282.35
47336
Metacarpal, treatment of fracture of, by closed reduction (Anaes.)
169.50
47339
Metacarpal, treatment of intra‑articular fracture of, by closed reduction (Anaes.)
197.60
47342
Metacarpal, treatment of fracture of, by open reduction (Anaes.)
226.00
47345
Metacarpal, treatment of intra‑articular fracture of, by open reduction (H) (Anaes.) (Assist.)
282.35
47348
Carpus (excluding scaphoid), treatment of fracture of, other than a service to which item 47351 applies (Anaes.)
94.00
47351
Carpus (excluding scaphoid), treatment of fracture of, by open reduction (Anaes.)
235.50
47354
Carpal scaphoid, treatment of fracture of, other than a service to which item 47357 applies (Anaes.)
169.50
47357
Carpal scaphoid, treatment of fracture of, by open reduction (Anaes.) (Assist.)
376.55
47360
Radius or ulna, distal end of, treatment of fracture of, by cast immobilisation, other than a service to which item 47363 or 47366 applies (Anaes.)
131.85
47363
Radius or ulna, distal end of, treatment of fracture of, by closed reduction (Anaes.)
197.60
47366
Radius or ulna, distal end of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
263.60
47369
Radius, distal end of, treatment of Colles’, Smith’s or Barton’s fracture of, by cast immobilisation, other than a service to which item 47372 or 47375 applies (Anaes.)
169.50
47372
Radius, distal end of, treatment of Colles’, Smith’s or Barton’s fracture, by closed reduction (Anaes.)
282.35
47375
Radius, distal end of, treatment of Colles’, Smith’s or Barton’s fracture, by open reduction (H) (Anaes.) (Assist.)
376.55
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.)
169.50
47381
Radius or ulna, shaft of, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (Anaes.)
254.20
47384
Radius or ulna, shaft of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
338.85
47385
Radius or ulna, shaft of, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by closed reduction undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
291.75
47386
Radius or ulna, shaft of, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by open reduction or internal fixation (H) (Anaes.) (Assist.)
470.70
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.)
272.95
47390
Radius and ulna, shafts of, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)
409.55
47393
Radius and ulna, shafts of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
546.00
47396
Olecranon, treatment of fracture of, other than a service to which item 47399 applies (Anaes.)
188.20
47399
Olecranon, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
376.55
47402
Olecranon, treatment of fracture of, involving excision of olecranon fragment and reimplantation of tendon (Anaes.) (Assist.)
282.35
47405
Radius, treatment of fracture of head or neck of, closed reduction of (Anaes.)
188.20
47408
Radius, treatment of fracture of head or neck of, open reduction of, including internal fixation and excision, if performed (H) (Anaes.) (Assist.)
376.55
47411
Humerus, treatment of fracture of tuberosity of, other than a service to which item 47417 applies (Anaes.)
112.85
47414
Humerus, treatment of fracture of tuberosity of, by open reduction (Anaes.)
226.00
47417
Humerus, treatment of fracture of tuberosity of, and associated dislocation of shoulder, by closed reduction (Anaes.) (Assist.)
263.60
47420
Humerus, treatment of fracture of tuberosity of, and associated dislocation of shoulder, by open reduction (H) (Anaes.) (Assist.)
517.80
47423
Humerus, proximal, treatment of fracture of, other than a service to which item 47426, 47429 or 47432 applies (Anaes.)
216.50
47426
Humerus, proximal, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
324.80
47429
Humerus, proximal, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
432.95
47432
Humerus, proximal, treatment of intra‑articular fracture of, by open reduction (H) (Anaes.) (Assist.)
541.30
47435
Humerus, proximal, treatment of fracture of, and associated dislocation of shoulder, by closed reduction (Anaes.) (Assist.)
414.25
47438
Humerus, proximal, treatment of fracture of, and associated dislocation of shoulder, by open reduction (H) (Anaes.) (Assist.)
659.15
47441
Humerus, proximal, treatment of intra‑articular fracture of, and associated dislocation of shoulder, by open reduction (H) (Anaes.) (Assist.)
823.75
47444
Humerus, shaft of, treatment of fracture of, other than a service to which item 47447 or 47450 applies (Anaes.)
226.00
47447
Humerus, shaft of, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (H) (Anaes.)
338.85
47450
Humerus, shaft of, treatment of fracture of, by internal or external (H) (Anaes.) (Assist.)
451.95
47451
Humerus, shaft of, treatment of fracture of, by intramedullary fixation (H) (Anaes.) (Assist.)
544.80
47453
Humerus, distal, (supracondylar or condylar), treatment of fracture of, other than a service to which item 47456 or 47459 applies (Anaes.) (Assist.)
263.60
47456
Humerus, distal (supracondylar or condylar), treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
395.50
47459
Humerus, distal (supracondylar or condylar), treatment of fracture of, by open reduction, undertaken in the operating theatre of a hospital (H) (Anaes.) (Assist.)
527.25
47462
Clavicle, treatment of fracture of, other than a service to which item 47465 applies (Anaes.)
112.85
47465
Clavicle, treatment of fracture of, by open reduction (Anaes.) (Assist.)
226.00
47466
Sternum, treatment of fracture of, other than a service to which item 47467 applies (Anaes.)
112.85
47467
Sternum, treatment of fracture of, by open reduction (H) (Anaes.)
226.00
47468
Scapula, neck or glenoid region of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
432.95
47471
Ribs (one or more), treatment of fracture of—each attendance
43.00
47474
Pelvic ring, treatment of fracture of, not involving disruption of pelvic ring or acetabulum
188.20
47477
Pelvic ring, treatment of fracture of, with disruption of pelvic ring or acetabulum
235.50
47480
Pelvic ring, treatment of fracture of, requiring traction (H) (Anaes.) (Assist.)
470.70
47483
Pelvic ring, treatment of fracture of, requiring control by external fixation (H) (Anaes.) (Assist.)
564.85
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.)
941.45
47489
Pelvic ring, treatment of fracture of, by open reduction and involving internal fixation of posterior segment (including sacro‑iliac joint), with or without fixation of anterior segment (H) (Anaes.) (Assist.)
1 412.20
47492
Acetabulum, treatment of fracture of, and associated dislocation of hip (Anaes.)
235.50
47495
Acetabulum, treatment of fracture of, and associated dislocation of hip, requiring traction (Anaes.) (Assist.)
470.70
47498
Acetabulum, treatment of fracture of, and associated dislocation of hip, requiring internal fixation, with or without traction (H) (Anaes.) (Assist.)
706.05
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.)
941.45
47504
Acetabulum, treatment of T‑shape 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.)
1 412.20
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.)
1 412.20
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.)
1 412.20
47513
Sacro‑iliac joint disruption, treatment of, requiring internal fixation, being a service associated with a service to which items 47501 to 47510 apply (H) (Anaes.) (Assist.)
376.55
47516
Femur, treatment of fracture of, by closed reduction or traction (Anaes.) (Assist.)
432.95
47519
Femur, treatment of trochanteric or subcapital fracture of, by internal fixation (H) (Anaes.) (Assist.)
866.20
47522
Femur, treatment of subcapital fracture of, by hemi‑arthroplasty (H) (Anaes.) (Assist.)
753.25
47525
Femur, treatment of fracture of, for slipped capital femoral epiphysis (H) (Anaes.) (Assist.)
866.20
47528
Femur, treatment of fracture of, by internal fixation or external fixation (H) (Anaes.) (Assist.)
753.25
47531
Femur, treatment of fracture of shaft, by intramedullary fixation and cross fixation (H) (Anaes.) (Assist.)
960.25
47534
Femur, condylar region of, treatment of intra‑articular (T‑shaped condylar) fracture of, requiring internal fixation, with or without internal fixation of one or more osteochondral fragments (H) (Anaes.) (Assist.)
1 082.70
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.)
432.95
47540
Hip spica or shoulder spica, application of, as an independent procedure (Anaes.)
216.50
47543
Tibia, plateau of, treatment of medial or lateral fracture of, other than a service to which item 47546 or 47549 applies (Anaes.)
226.00
47546
Tibia, plateau of, treatment of medial or lateral fracture of, by closed reduction (Anaes.)
338.85
47549
Tibia, plateau of, treatment of medial or lateral fracture of, by open reduction (H) (Anaes.) (Assist.)
451.95
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.)
376.55
47555
Tibia, plateau of, treatment of both medial and lateral fractures of, by closed reduction (H) (Anaes.)
564.85
47558
Tibia, plateau of, treatment of both medial and lateral fractures of, by open reduction (H) (Anaes.) (Assist.)
753.25
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.)
272.95
47564
Tibia, shaft of, treatment of fracture of, by closed reduction, with or without treatment of fibular fracture (Anaes.)
409.55
47565
Tibia, shaft of, treatment of fracture of, by internal fixation or external fixation (H) (Anaes.) (Assist.)
712.40
47566
Tibia, shaft of, treatment of fracture of, by intramedullary fixation and cross fixation (H) (Anaes.) (Assist.)
908.05
47567
Tibia, shaft of, treatment of intra‑articular fracture of, by closed reduction, with or without treatment of fibular fracture (Anaes.) (Assist.)
475.35
47570
Tibia, shaft of, treatment of fracture of, by open reduction, with or without treatment of fibular fracture (Anaes.) (Assist.)
546.00
47573
Tibia, shaft of, treatment of intra‑articular fracture of, by open reduction, with or without treatment of fibular fracture (H) (Anaes.) (Assist.)
682.55
47576
Fibula, treatment of fracture of (Anaes.)
112.85
47579
Patella, treatment of fracture of, other than a service to which item 47582 or 47585 applies (Anaes.)
160.05
47582
Patella, treatment of fracture of, by excision of patella or pole with reattachment of tendon (H) (Anaes.) (Assist.)
329.60
47585
Patella, treatment of fracture of, by internal fixation (H) (Anaes.) (Assist.)
423.75
47588
Knee joint, treatment of fracture of, by internal fixation of intra‑articular fractures of femoral condylar or tibial articular surfaces and requiring repair or reconstruction of one or more ligaments (H) (Anaes.) (Assist.)
1 317.80
47591
Knee joint, treatment of fracture of, by internal fixation of intra‑articular fractures of femoral condylar and tibial articular surfaces and requiring repair or reconstruction of one or more ligaments (H) (Anaes.) (Assist.)
1 600.65
47594
Ankle joint, treatment of fracture of, other than a service to which item 47597 applies (Anaes.)
216.50
47597
Ankle joint, treatment of fracture of, by closed reduction (Anaes.)
324.80
47600
Ankle joint, treatment of fracture of, by internal fixation of one of malleolus, fibula or diastasis (H) (Anaes.) (Assist.)
432.95
47603
Ankle joint, treatment of fracture of, by internal fixation of more than one of malleolus, fibula or diastasis (H) (Anaes.) (Assist.)
564.85
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.)
235.50
47609
Calcaneum or talus, treatment of fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)
353.05
47612
Calcaneum or talus, treatment of intra‑articular fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)
409.55
47615
Calcaneum or talus, treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)
470.70
47618
Calcaneum or talus, treatment of intra‑articular fracture of, by open reduction, with or without dislocation (H) (Anaes.) (Assist.)
588.45
47621
Tarso‑metatarsal, treatment of intra‑articular fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)
409.55
47624
Tarso‑metatarsal, treatment of fracture of, by open reduction, with or without dislocation (H) (Anaes.) (Assist.)
564.85
47627
Tarsus (excluding calcaneum or talus), treatment of fracture of (Anaes.)
160.05
47630
Tarsus (excluding calcaneum or talus), treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)
338.85
47633
Metatarsal, one of, treatment of fracture of (Anaes.)
112.85
47636
Metatarsal, one of, treatment of fracture of, by closed reduction (Anaes.)
169.50
47639
Metatarsal, one of, treatment of fracture of, by open reduction (Anaes.)
226.00
47642
Metatarsals, 2 of, treatment of fracture of (Anaes.)
150.75
47645
Metatarsals, 2 of, treatment of fracture of, by closed reduction (Anaes.)
226.00
47648
Metatarsals, 2 of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
301.05
47651
Metatarsals, 3 or more of, treatment of fracture of (Anaes.)
235.50
47654
Metatarsals, 3 or more of, treatment of fracture of, by closed reduction (Anaes.) (Assist.)
353.05
47657
Metatarsals, 3 or more of, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
470.70
47663
Phalanx of great toe, treatment of fracture of, by closed reduction (Anaes.)
141.25
47666
Phalanx of great toe, treatment of fracture of, by open reduction (Anaes.)
235.50
47672
Phalanx of toe (other than great toe), one of, treatment of fracture of, by open reduction (Anaes.)
112.85
47678
Phalanx of toe (other than great toe), more than one of, treatment of fracture of, by open reduction (Anaes.)
169.50
47681
Spine (excluding sacrum), treatment of fracture of transverse process, vertebral body, or posterior elements—each attendance
43.00
47684
Spine, treatment of fracture, dislocation or fracture‑dislocation, without spinal cord involvement, by means of immobilisation by calipers or halo (Anaes.) (Assist.)
753.25
47687
Spine, treatment of fracture, dislocation or fracture‑dislocation, with spinal cord involvement, by means of immobilisation by calipers or halo, requiring not more than 14 days post‑operative care (H) (Assist.)
1 317.80
47690
Spine, treatment of fracture, dislocation or fracture‑dislocation, without cord involvement, by means of immobilisation by calipers or halo, requiring reduction by closed manipulation (H) (Anaes.) (Assist.)
1 035.55
47693
Spine, treatment of fracture, dislocation or fracture‑dislocation, with cord involvement, by means of immobilisation by calipers or halo, requiring reduction by closed manipulation and not more than 14 days post‑operative care (H) (Assist.)
1 317.80
47696
Spine, reduction of fracture or dislocation of, without cord involvement, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
376.55
47699
Spine, treatment of fracture, dislocation or fracture‑dislocation without cord involvement requiring open reduction with or without internal fixation (H) (Anaes.) (Assist.)
1 506.45
47702
Spine, treatment of fracture, dislocation or fracture‑dislocation with cord involvement requiring open reduction with or without internal fixation, including up to 14 days post‑operative care (H) (Anaes.) (Assist.)
1 882.95
47703
Skull, treatment of fracture of, each attendance
43.00
47705
Skull callipers, insertion of, as an independent procedure (H) (Anaes.) (Assist.)
282.35
47708
Plaster jacket, application of, as an independent procedure (Anaes.)
216.50
47711
Halo, application of, as an independent procedure (H) (Anaes.) (Assist.)
320.15
47714
Halo, application of, in addition to spinal fusion for scoliosis, or other conditions (H) (Anaes.)
240.05
47717
Halo‑thoracic traction—application of both halo and thoracic jacket (H) (Anaes.) (Assist.)
423.75
47720
Halo‑femoral traction, as an independent procedure (Anaes.) (Assist.)
423.75
47723
Halo‑femoral traction in conjunction with a major spine operation (Anaes.) (Assist.)
423.75
47726
Bone graft, harvesting of, via separate incision, in conjunction with another service, autogenous, small quantity (H) (Anaes.)
141.25
47729
Bone graft, harvesting of, via separate incision, in conjunction with another service, autogenous, large quantity (H) (Anaes.)
235.50
47732
Vascularised pedicle bone graft, harvesting of, in conjunction with another service (H) (Anaes.) (Assist.)
376.55
47735
Nasal bones, treatment of fracture of, other than a service to which item 47738 or 47741 applies—each attendance
43.05
47738
Nasal bones, treatment of fracture of, by reduction (Anaes.)
235.50
47741
Nasal bones, treatment of fracture of, by open reduction involving osteotomies (H) (Anaes.) (Assist.)
480.35
47753
Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (H) (Anaes.) (Assist.)
406.65
47756
Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (H) (Anaes.) (Assist.)
406.65
47762
Zygomatic bone, treatment of fracture of, requiring surgical reduction by a temporal, intra‑oral or other approach (Anaes.)
238.80
47765
Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at one site (H) (Anaes.) (Assist.)
392.10
47768
Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (H) (Anaes.) (Assist.)
480.35
47771
Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (H) (Anaes.) (Assist.)
551.85
47774
Maxilla, treatment of fracture of, requiring open operation (H) (Anaes.) (Assist.)
435.65
47777
Mandible, treatment of fracture of, requiring open reduction (H) (Anaes.) (Assist.)
435.65
47780
Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (H) (Anaes.) (Assist.)
566.35
47783
Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)
566.35
47786
Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (H) (Anaes.) (Assist.)
718.75
47789
Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (H) (Anaes.) (Assist.)
718.75
47900
Bone cyst, injection into or aspiration of (Anaes.)
169.50
47903
Epicondylitis, open operation for (Anaes.)
235.50
47904
Digital nail of toe, removal of, other than a service to which item 47906 applies (Anaes.)
56.50
47906
Digital nail of toe, removal of, in the operating theatre of a hospital (Anaes.)
112.85
47912
Pulp space infection, paronychia of foot, incision for, other than a service to which another item in this Group applies (excluding after‑care) (Anaes.)
56.50
47915
Ingrowing nail of toe, wedge resection for, with removal of segment of nail, ungual fold and portion of the nail bed (Anaes.)
169.50
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.)
85.15
47918
Ingrowing toenail, radical excision of nailbed (Anaes.)
235.50
47920
Bone growth stimulator, insertion of (H) (Anaes.) (Assist.)
380.80
47921
Orthopaedic pin or wire, insertion of, as an independent procedure (Anaes.)
112.85
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.)
37.65
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.)
141.25
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.)
263.60
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.)
207.00
47936
Large exostosis (greater than 20 mm growth above bone), excision of (H) (Anaes.) (Assist.)
254.20
47948
External fixation, removal of, in the operating theatre of a hospital (H) (Anaes.)
160.05
47951
External fixation, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)
188.20
47954
Tendon, repair of, as an independent procedure (Anaes.) (Assist.)
376.55
47957
Tendon, large, lengthening of, as an independent procedure (H) (Anaes.) (Assist.)
282.35
47960
Tenotomy, subcutaneous, other than a service to which another item in this Group applies (Anaes.)
131.85
47963
Tenotomy, open, with or without tenoplasty, other than a service to which another item in this Group applies (Anaes.)
216.50
47966
Tendon or ligament transfer, as an independent procedure (H) (Anaes.) (Assist.)
432.95
47969
Tenosynovectomy, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
263.60
47972
Tendon sheath, open operation for teno‑vaginitis, other than a service to which another item in this Group applies (H) (Anaes.)
210.60
47975
Forearm or calf, decompression fasciotomy of, for acute compartment syndrome, requiring excision of muscle and deep tissue (H) (Anaes.) (Assist.)
369.15
47978
Forearm or calf, decompression fasciotomy of, for chronic compartment syndrome, requiring excision of muscle and deep tissue (H) (Anaes.)
224.20
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.)
150.55
47982
Forage (Drill decompression), of neck or head of femur, or both (H) (Anaes.) (Assist.)
364.90
48200
Femur, bone graft to (H) (Anaes.) (Assist.)
753.25
48203
Femur, bone graft to, with internal fixation (H) (Anaes.) (Assist.)
913.25
48206
Tibia, bone graft to (H) (Anaes.) (Assist.)
565.45
48209
Tibia, bone graft to, with internal fixation (H) (Anaes.) (Assist.)
724.95
48212
Humerus, bone graft to (H) (Anaes.) (Assist.)
565.45
48215
Humerus, bone graft to, with internal fixation (H) (Anaes.) (Assist.)
724.95
48218
Radius or ulna, bone graft to (H) (Anaes.) (Assist.)
565.45
48221
Radius and ulna, bone graft to, with internal fixation of one or both bones (H) (Anaes.) (Assist.)
753.25
48224
Radius or ulna, bone graft to (H) (Anaes.) (Assist.)
376.55
48227
Radius or ulna, bone graft to, with internal fixation of one or both bones (H) (Anaes.) (Assist.)
489.55
48230
Scaphoid, bone graft to, for non‑union (H) (Anaes.) (Assist.)
423.75
48233
Scaphoid, bone graft to, for non‑union, with internal fixation (H) (Anaes.) (Assist.)
611.90
48236
Scaphoid, bone graft to, for mal‑union, including osteotomy, bone graft and internal fixation (H) (Anaes.) (Assist.)
800.20
48239
Bone graft, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
442.45
48242
Bone graft, with internal fixation, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
611.90
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.)
329.60
48403
Phalanx or metatarsal, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
517.80
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.)
329.60
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.)
517.80
48412
Humerus, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
630.65
48415
Humerus, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
800.20
48418
Tibia, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
630.65
48421
Tibia, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
800.20
48424
Femur or pelvis, osteotomy or osteectomy of, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
753.25
48427
Femur or pelvis, osteotomy or osteectomy of, with internal fixation, excluding services to which item 47933 or 47936 applies (H) (Anaes.) (Assist.)
913.25
48500
Femur, epiphysiodesis of (H) (Anaes.) (Assist.)
329.60
48503
Tibia and fibula, epiphysiodesis of (H) (Anaes.) (Assist.)
329.60
48506
Femur, tibia and fibula, epiphysiodesis of (H) (Anaes.) (Assist.)
489.55
48509
Epiphysiodesis, staple arrest of hemi‑epiphysis (H) (Anaes.)
235.50
48512
Epiphysiolysis, operation to prevent closure of plate (H) (Anaes.) (Assist.)
894.40
48600
Spine, manipulation of, performed in the operating theatre of a hospital (H) (Anaes.)
94.00
48603
Spine, manipulation of, under epidural anaesthesia, with or without steroid injection, if the manipulation and the administration of the epidural anaesthetic are performed by the same medical practitioner in the operating theatre of a hospital, other than a service associated with a service to which item 48600 or 50115 applies (Anaes.)
141.25
48606
Scoliosis or Kyphosis, spinal fusion for (without instrumentation) (H) (Anaes.) (Assist.)
1 317.80
48612
Scoliosis, spinal fusion for, using segmental instrumentation (C D, Zielke, Luque, or similar) (H) (Anaes.) (Assist.)
2 447.85
48613
Scoliosis or Kyphosis, spinal fusion for, using segmental instrumentation, reconstruction using separate anterior and posterior approaches (H) (Anaes.) (Assist.)
3 481.80
48615
Scoliosis, re‑exploration for, involving adjustment or removal of instrumentation or simple bone grafting procedure (H) (Anaes.) (Assist.)
442.45
48618
Scoliosis, revision of failed scoliosis surgery, involving more than one of multiple osteotomy, fusion or instrumentation (H) (Anaes.) (Assist.)
2 447.85
48621
Scoliosis, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke, or similar)—not more than 4 levels (H) (Anaes.) (Assist.)
1 600.65
48624
Scoliosis, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar)—more than 4 levels (H) (Anaes.) (Assist.)
1 977.20
48627
Scoliosis, spinal fusion for, combined with segmental instrumentation (C D, Zielke or similar) down to and including pelvis (H) (Anaes.) (Assist.)
2 541.85
48630
Scoliosis, requiring anterior decompression of spinal cord with resection of vertebrae including bone graft and instrumentation in the presence of spinal cord involvement (H) (Anaes.) (Assist.)
2 824.35
48632
Scoliosis, congenital, vertebral resection and fusion for (H) (Anaes.) (Assist.)
1 561.30
48636
Percutaneous lumbar partial or total discectomy, one or more levels, other than a service associated with intradiscal electrothermal annuloplasty (Anaes.) (Assist.)
809.55
48639
Vertebral body, total or sub‑total excision of, including bone grafting or other form of fixation (H) (Anaes.) (Assist.)
1 365.00
48640
Vertebral body, disease of, excision and spinal fusion for, using segmental instrumentation, reconstruction utilising separate anterior and posterior approaches (H) (Anaes.) (Assist.)
3 481.80
48642
Spine, posterior, bone graft to, other than a service to which item 48648 or 48651 applies—one or 2 levels (H) (Anaes.) (Assist.)
800.20
48645
Spine, posterior, bone graft to, other than a service to which item 48648 or 48651 applies—more than 2 levels (H) (Anaes.) (Assist.)
1 082.70
48648
Spine, bone graft to, (postero‑lateral fusion)—one or 2 levels (H) (Anaes.) (Assist.)
1 082.70
48651
Spine, bone graft to, (postero‑lateral fusion)—more than 2 levels (H) (Anaes.) (Assist.)
1 506.45
48654
Spinal fusion (posterior interbody), with partial or total laminectomy—one level (H) (Anaes.) (Assist.)
1 082.70
48657
Spinal fusion (posterior interbody), with partial or total laminectomy—more than one level (H) (Anaes.) (Assist.)
1 506.45
48660
Spinal fusion (anterior interbody) to cervical, thoracic or lumbar regions—one level (H) (Anaes.) (Assist.)
1 082.70
48663
Spinal fusion (anterior interbody) to cervical, thoracic or lumbar regions—one level—principal surgeon (H) (Anaes.)
809.55
48666
Spinal fusion (anterior interbody) to cervical, thoracic or lumbar regions—one level—assisting surgeon (H)
489.55
48669
Spinal fusion (anterior interbody) to cervical, thoracic or lumbar regions—more than one level (H) (Anaes.) (Assist.)
1 459.20
48672
Spinal fusion (anterior interbody) to cervical, thoracic or lumbar regions—more than one level—principal surgeon (H) (Anaes.)
1 092.25
48675
Spinal fusion (anterior interbody) to cervical, thoracic or lumbar regions—more than one level assisting surgeon (H)
659.15
48678
Spine, simple internal fixation of, involving one or more of facetal screw, wire loop or similar, being a service associated with a service to which items 48642 to 48675 apply (H) (Anaes.) (Assist.)
565.45
48681
Spine, non‑segmental internal fixation of (Harrington or similar), other than for scoliosis, being a service associated with a service to which any one of items 48642 to 48675 applies (H) (Anaes.) (Assist.)
941.45
48684
Spine, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which any one of items 48642 to 48675 applies—one or 2 levels (H) (Anaes.) (Assist.)
941.45
48687
Spine, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which items 48642 to 48675 apply—3 or 4 levels (H) (Anaes.) (Assist.)
1 317.80
48690
Spine, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which items 48642 to 48675 apply—more than 4 levels (H) (Anaes.) (Assist.)
1 506.45
48691
Lumbar artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:
(a) has not had prior spinal fusion surgery at the same lumbar level; and
(b) does not have vertebral osteoporosis; and
(c) has failed conservative therapy;
other than a service associated with item 40300 or 40301 (Anaes.) (Assist.)
1 793.65
48692
Lumbar artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:
(a) has not had prior spinal fusion surgery at the same lumbar level; and
(b) does not have vertebral osteoporosis; and
(c) has failed conservative therapy;
other than a service associated with item 40300 or 40301—principal surgeon (Anaes.) (Assist.)
1 208.95
48693
Lumbar artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:
(a) has not had prior spinal fusion surgery at the same lumbar level; and
(b) does not have vertebral osteoporosis; and
(c) has failed conservative therapy;
other than a service associated with item 40300 or 40301—assisting surgeon (Anaes.) (Assist.)
584.70
48694
Cervical artificial intervertebral total disc replacement, at one level only, including removal of disc, 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;
other than a service associated with item 40300 or 40301 (H) (Anaes.) (Assist.)
1 082.70
48900
Shoulder, excision of coraco‑acromial ligament or removal of calcium deposit from cuff or both (Anaes.) (Assist.)
282.35
48903
Shoulder, decompression of subacromial space by acromioplasty, excision of coraco‑acromial ligament and distal clavicle, or any combination (H) (Anaes.) (Assist.)
564.85
48906
Shoulder, repair of rotator cuff, including excision of coraco‑acromial 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.)
564.85
48909
Shoulder, repair of rotator cuff, including decompression of subacromial space by acromioplasty, excision of coraco‑acromial ligament and distal clavicle, or any combination, other than a service associated with a service to which item 48903 applies (H) (Anaes.) (Assist.)
753.25
48912
Shoulder, arthrotomy of (Anaes.) (Assist.)
329.60
48915
Shoulder, hemi‑arthroplasty of (H) (Anaes.) (Assist.)
753.25
48918
Shoulder, total replacement arthroplasty of, including any associated rotator cuff repair (H) (Anaes.) (Assist.)
1 506.45
48921
Shoulder, total replacement arthroplasty, revision of (H) (Anaes.) (Assist.)
1 553.40
48924
Shoulder, total replacement arthroplasty, revision of, requiring bone graft to scapula or humerus, or both (H) (Anaes.) (Assist.)
1 788.85
48927
Shoulder prosthesis, removal of (H) (Anaes.) (Assist.)
367.05
48930
Shoulder, stabilisation procedure for recurrent anterior or posterior dislocation (H) (Anaes.) (Assist.)
753.25
48933
Shoulder, stabilisation procedure for multi‑directional instability, anterior or posterior (or both) repair when performed (H) (Anaes.) (Assist.)
988.55
48936
Shoulder, synovectomy of, as an independent procedure (H) (Anaes.) (Assist.)
753.25
48939
Shoulder, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
1 082.70
48942
Shoulder, arthrodesis of, with synovectomy if performed, with removal of prosthesis, requiring bone grafting or internal fixation (H) (Anaes.) (Assist.)
1 412.20
48945
Shoulder, diagnostic arthroscopy of (including biopsy)—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)
272.95
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.)
611.90
48951
Shoulder, arthroscopic division of coraco‑acromial ligament including acromioplasty—other than a service associated with another arthroscopic procedure of the shoulder region (H) (Anaes.) (Assist.)
894.40
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.)
941.45
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.)
1 082.70
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.)
941.45
49100
Elbow, arthrotomy of, involving one or more of lavage, removal of loose body or division of contracture (H) (Anaes.) (Assist.)
329.60
49103
Elbow, ligamentous stabilisation of (H) (Anaes.) (Assist.)
706.05
49106
Elbow, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
941.45
49109
Elbow, total synovectomy of (H) (Anaes.) (Assist.)
706.05
49112
Elbow, silastic or other replacement of radial head (H) (Anaes.) (Assist.)
706.05
49115
Elbow, total joint replacement of (H) (Anaes.) (Assist.)
1 129.65
49116
Elbow, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)
1 491.15
49117
Elbow, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (H) (Anaes.) (Assist.)
1 789.35
49118
Elbow, diagnostic arthroscopy of, including biopsy and lavage, other than a service associated with another arthroscopic procedure of the elbow (H) (Anaes.) (Assist.)
272.95
49121
Elbow, arthroscopic surgery involving any one or more of: drilling of defect; removal of loose body; release of contracture or adhesions; chondroplasty; or osteoplasty—other than a service associated with another arthroscopic procedure of the elbow (H) (Anaes.) (Assist.)
611.90
49200
Wrist, arthrodesis of, with synovectomy if performed, with or without bone graft and internal fixation of the radiocarpal joint (H) (Anaes.) (Assist.)
818.95
49203
Wrist, limited arthrodesis of the intercarpal joint, with synovectomy if performed, with or without bone graft (H) (Anaes.) (Assist.)
611.90
49206
Wrist, proximal carpectomy of, including styloidectomy when performed (H) (Anaes.) (Assist.)
564.85
49209
Wrist, total replacement arthroplasty of (H) (Anaes.) (Assist.)
753.25
49210
Wrist, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)
994.30
49211
Wrist, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (H) (Anaes.) (Assist.)
1 193.15
49212
Wrist, arthrotomy of (H) (Anaes.)
235.50
49215
Wrist, reconstruction of, including repair of single or multiple ligaments or capsules, including associated arthrotomy (H) (Anaes.) (Assist.)
649.70
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.)
272.95
49221
Wrist, arthroscopic surgery of, involving any one or more of: drilling of defect; removal of loose body, release of adhesions; local synovectomy; or debridement of one area—other than a service associated with another arthroscopic procedure of the wrist joint (H) (Anaes.) (Assist.)
611.90
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.)
706.05
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.)
706.05
49300
Sacro‑iliac joint—arthrodesis of (H) (Anaes.) (Assist.)
521.25
49303
Hip, arthrotomy of, including lavage, drainage or biopsy when performed (H) (Anaes.) (Assist.)
546.00
49306
Hip‑arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
1 082.70
49309
Hip, arthrectomy or excision arthroplasty of, including removal of prosthesis (Austin Moore or similar (non cement)) (H) (Anaes.) (Assist.)
753.25
49312
Hip, arthrectomy or excision arthroplasty of, including removal of prosthesis (cemented, porous coated or similar) (H) (Anaes.) (Assist.)
941.45
49315
Hip, arthroplasty of, unipolar or bipolar (H) (Anaes.) (Assist.)
847.35
49318
Hip, total replacement arthroplasty of, including minor bone grafting (H) (Anaes.) (Assist.)
1 317.80
49319
Hip, total replacement arthroplasty of, including associated minor grafting, if performed—bilateral (H) (Anaes.) (Assist.)
2 315.30
49321
Hip, total replacement arthroplasty of, including major bone grafting, including obtaining of graft (H) (Anaes.) (Assist.)
1 600.65
49324
Hip, total replacement arthroplasty of, revision procedure including removal of prosthesis (H) (Anaes.) (Assist.)
1 882.95
49327
Hip, total replacement arthroplasty of, revision procedure requiring bone grafting to acetabulum, including obtaining of graft (H) (Anaes.) (Assist.)
2 165.35
49330
Hip, total replacement arthroplasty of, revision procedure requiring bone grafting to femur, including obtaining of graft (H) (Anaes.) (Assist.)
2 165.35
49333
Hip, total replacement arthroplasty of, revision procedure requiring bone grafting to both acetabulum and femur, including obtaining of graft (H) (Anaes.) (Assist.)
2 447.85
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 intra‑operative fracture), being a service associated with a service to which items 49324 to 49333 apply (H) (Anaes.) (Assist.)
357.70
49339
Hip, revision total replacement of, requiring anatomic specific allograft of proximal femur greater than 5 cm in length (H) (Anaes.) (Assist.)
2 777.30
49342
Hip, revision total replacement of, requiring anatomic specific allograft of acetabulum (H) (Anaes.) (Assist.)
2 777.30
49345
Hip, revision total replacement of, requiring anatomic specific allograft of both femur and acetabulum (H) (Anaes.) (Assist.)
3 295.10
49346
Hip, revision arthroplasty with replacement of acetabular liner or ceramic head, not requiring removal of femoral component or acetabular shell (H) (Anaes.) (Assist.)
847.35
49360
Hip, diagnostic arthroscopy of, other than a service associated with another arthroscopic procedure of the hip (H) (Anaes.) (Assist.)
343.95
49363
Hip, diagnostic arthroscopy of, with synovial biopsy, other than a service associated with another arthroscopic procedure of the hip (H) (Anaes.) (Assist.)
414.20
49366
Hip, arthroscopic surgery of, other than a service associated with another arthroscopic procedure of the hip (H) (Anaes.) (Assist.)
611.90
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.)
376.55
49503
Knee, partial or total meniscectomy of, repair of collateral or cruciate ligament, patellectomy of, chondroplasty of, osteoplasty of, patello‑femoral 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.)
489.55
49506
Knee, partial or total meniscectomy of, repair of collateral or cruciate ligament, patellectomy of, chondroplasty of, osteoplasty of, patello‑femoral 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.)
734.40
49509
Knee, total synovectomy or arthrodesis with synovectomy if performed (H) (Anaes.) (Assist.)
753.25
49512
Knee, arthrodesis of, with synovectomy if performed, with removal of prosthesis (H) (Anaes.) (Assist.)
1 082.70
49515
Knee, removal of prosthesis, cemented or uncemented, including associated cement, as the first stage of a 2 stage procedure (H) (Anaes.) (Assist.)
847.35
49517
Knee, hemiarthroplasty of (H) (Anaes.) (Assist.)
1 206.35
49518
Knee, total replacement arthroplasty of (H) (Anaes.) (Assist.)
1 317.80
49519
Knee, total replacement arthroplasty of, including associated minor grafting, if performed—bilateral (H) (Anaes.) (Assist.)
2 315.30
49521
Knee, total replacement arthroplasty of, requiring major bone grafting to femur or tibia, including obtaining of graft (H) (Anaes.) (Assist.)
1 600.65
49524
Knee, total replacement arthroplasty of, requiring major bone grafting to femur and tibia, including obtaining of graft (H) (Anaes.) (Assist.)
1 882.95
49527
Knee, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)
1 600.65
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.)
1 977.20
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.)
2 259.65
49534
Knee, patello‑femoral joint of, total replacement arthroplasty as a primary procedure (H) (Anaes.) (Assist.)
449.55
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.)
941.45
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.)
941.45
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.)
1 317.80
49545
Knee, revision arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
753.25
49548
Knee, revision of patello‑femoral stabilisation (H) (Anaes.) (Assist.)
941.45
49551
Knee, revision of procedures to which item 49536, 49539 or 49542 applies (H) (Anaes.) (Assist.)
1 317.80
49554
Knee, revision of total replacement of, by anatomic specific allograft of tibia or femur (H) (Anaes.) (Assist.)
1 882.95
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) matrix‑induced autologous chondrocyte implantation; or
(c) another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)
272.95
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.)
272.95
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.)
408.70
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.)
551.60
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.)
674.00
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.)
735.50
49563
Knee, arthroscopic surgery of, involving one or more of:
(a) meniscus repair; or
(b) osteochondral graft; or
(c) chondral graft
—excluding autologous chondrocyte implantation or matrix‑induced autologous chondrocyte implantation and not associated with another arthroscopic procedure of the knee region (H) (Anaes.) (Assist.)
796.70
49564
Knee, patello‑femoral 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.)
919.05
49566
Knee, arthroscopic total synovectomy of, other than a service associated with another arthroscopic procedure of the knee (H) (Anaes.) (Assist.)
753.25
49569
Knee, mobilisation for post‑traumatic stiffness, by multiple muscle or tendon release (quadricepsplasty) (H) (Anaes.) (Assist.)
753.25
49700
Ankle, diagnostic arthroscopy of, including biopsy (H) (Anaes.) (Assist.)
272.95
49703
Ankle, arthroscopic surgery of (H) (Anaes.) (Assist.)
611.90
49706
Ankle, arthrotomy of, involving one or more of: lavage, removal of loose body or division of contracture (H) (Anaes.) (Assist.)
329.60
49709
Ankle, ligamentous stabilisation of (H) (Anaes.) (Assist.)
706.05
49712
Ankle, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
753.25
49715
Ankle, total joint replacement of (H) (Anaes.) (Assist.)
1 129.65
49716
Ankle, total replacement arthroplasty of, revision procedure, including removal of prosthesis (H) (Anaes.) (Assist.)
1 491.15
49717
Ankle, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (H) (Anaes.) (Assist.)
1 789.35
49718
Ankle, Achilles’ tendon or other major tendon, repair of (H) (Anaes.) (Assist.)
376.55
49721
Ankle, Achilles’ tendon rupture managed by non‑operative treatment
235.50
49724
Ankle, Achilles’ tendon, secondary repair or reconstruction of (H) (Anaes.) (Assist.)
659.15
49727
Ankle, Achilles’ tendon, operation for lengthening (H) (Anaes.) (Assist.)
282.35
49728
Ankle, lengthening of the gastrocnemius aponeurosis and soleus fascia, for the correction of equinus deformity in children with cerebral palsy (H) (Anaes.) (Assist.)
564.70
49800
Foot, flexor or extensor tendon, primary repair of (Anaes.)
131.85
49803
Foot, flexor or extensor tendon, secondary repair of (Anaes.)
169.50
49806
Foot, subcutaneous tenotomy of, one or more tendons (Anaes.)
131.85
49809
Foot, open tenotomy of, with or without tenoplasty (H) (Anaes.)
216.50
49812
Foot, tendon or ligament transplantation of, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
432.95
49815
Foot, triple arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
753.25
49818
Foot, excision of calcaneal spur (H) (Anaes.) (Assist.)
272.95
49821
Foot, correction of hallux valgus or hallux rigidus by excision arthroplasty (Keller’s or similar procedure)—unilateral (H) (Anaes.) (Assist.)
432.95
49824
Foot, correction of hallux valgus or hallux rigidus by excision arthroplasty (Keller’s or similar procedure)—bilateral (H) (Anaes.) (Assist.)
757.95
49827
Foot, correction of hallux valgus by transfer of adductor hallucis tendon—unilateral (H) (Anaes.) (Assist.)
470.70
49830
Foot, correction of hallux valgus by transfer of adductor hallucis tendon—bilateral (H) (Anaes.) (Assist.)
823.75
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.)
517.80
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.)
894.40
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.)
647.25
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.)
1 117.75
49839
Foot, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty—unilateral (H) (Anaes.) (Assist.)
517.80
49842
Foot, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty—bilateral (H) (Anaes.) (Assist.)
894.40
49845
Foot, arthrodesis of, first metatarso‑phalangeal joint, with synovectomy if performed (H) (Anaes.) (Assist.)
470.70
49848
Foot, correction of claw or hammer toe (Anaes.)
160.05
49851
Foot, correction of claw or hammer toe with internal fixation (H) (Anaes.)
207.00
49854
Foot, radical plantar fasciotomy or fasciectomy of (H) (Anaes.) (Assist.)
376.55
49857
Foot, metatarso‑phalangeal joint replacement (H) (Anaes.) (Assist.)
348.35
49860
Foot, synovectomy of metatarso‑phalangeal joint, single joint (H) (Anaes.) (Assist.)
282.35
49863
Foot, synovectomy of metatarso‑phalangeal joint, 2 or more joints (H) (Anaes.) (Assist.)
423.75
49866
Foot, neurectomy for plantar or digital neuritis (Morton’s or Bett’s syndrome) (H) (Anaes.) (Assist.)
301.05
49878
Talipes equinovarus, calcaneo valgus or metatarsus varus, treatment by cast, splint or manipulation—each attendance (Anaes.)
56.50
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.)
272.95
50102
Joint, arthroscopic surgery of, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
611.90
50103
Joint, arthrotomy of, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
329.60
50104
Joint, synovectomy of, other than a service to which another item in this Group applies (Anaes.) (Assist.)
312.30
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.)
470.70
50109
Joint, arthrodesis of, other than a service to which another item in this Group applies, with synovectomy if performed (H) (Anaes.) (Assist.)
470.70
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.)
361.05
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 (Anaes.)
142.95
50118
Subtalar joint, arthrodesis of, with synovectomy if performed (H) (Anaes.) (Assist.)
432.95
50121
Greater trochanter, transplantation of ileopsoas tendon to (H) (Anaes.) (Assist.)
847.35
50127
Joint or joints, arthroplasty of, by any technique other than a service to which another item applies (H) (Anaes.) (Assist.)
702.50
50130
Joint or joints, application of external fixator to, other than for treatment of fractures (H) (Anaes.) (Assist.)
312.30
50200
Aggressive or potentially malignant bone or deep soft tissue tumour, biopsy of (not including after‑care) (Anaes.)
188.20
50201
Aggressive or potentially malignant bone or deep soft tissue tumour involving neurovascular structures, open biopsy of (not including after‑care) (Anaes.) (Assist.)
329.50
50203
Bone or malignant deep soft tissue tumour, lesional or marginal excision of (Anaes.) (Assist.)
414.25
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.)
611.90
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.)
753.25
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.)
1 647.55
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.)
2 071.20
50218
Malignant tumour of long bone, enbloc resection of, with replacement or arthrodesis of adjacent joint, with synovectomy if performed (H) (Anaes.) (Assist.)
2 730.30
50221
Malignant or aggressive soft tissue tumour of pelvis, sacrum or spine; or scapula and shoulder, enbloc resection of (H) (Anaes.) (Assist.)
2 541.85
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.)
2 824.35
50227
Malignant bone tumour, enbloc resection of, with massive anatomic specific allograft or autograft, with or without prosthetic replacement (H) (Anaes.) (Assist.)
3 295.10
50230
Benign tumour, resection of, requiring anatomic specific allograft, with or without internal fixation (H) (Anaes.) (Assist.)
1 694.60
50233
Malignant tumour, amputation for, hemipelvectomy or interscapulo‑thoracic (H) (Anaes.) (Assist.)
2 165.35
50236
Malignant tumour, amputation for, hip disarticulation, shoulder disarticulation or proximal third femur (H) (Anaes.) (Assist.)
1 694.60
50239
Malignant tumour, amputation for, other than a service to which another item in this Group applies (H) (Anaes.) (Assist.)
1 129.65
50300
Joint deformity, slow correction of, using ring fixator or similar device, including all associated attendances—payable only once in any 12 month period (H) (Anaes.) (Assist.)
1 157.70
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.)
1 580.60
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.)
2 467.90
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.)
305.05
50312
Ankle, synovectomy of, by arthroscopic or other means—not associated with another arthroscopic procedure of the ankle (H) (Anaes.) (Assist.)
700.10
50315
Talipes equinovarus, posterior release of (H) (Anaes.) (Assist.)
693.30
50318
Talipes equinovarus, medial release of (H) (Anaes.) (Assist.)
693.30
50321
Talipes equinovarus, combined postero‑medial release of (H) (Anaes.) (Assist.)
928.85
50324
Talipes equinovarus, combined postero‑medial release of, revision procedure (H) (Anaes.) (Assist.)
1 324.15
50327
Talipes equinovarus, bilateral procedures (H) (Anaes.) (Assist.)
1 615.15
50330
Talipes equinovarus, or talus, vertical congenital—post operative 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 (Anaes.)
228.70
50333
Tarsal coalition, excision of, with interposition of muscle, fat graft or similar graft (H) (Anaes.) (Assist.)
616.85
50336
Talus, vertical, congenital, combined anterior and posterior reconstruction (H) (Anaes.) (Assist.)
922.05
50339
Foot and ankle, tibialis anterior tendon (split or whole) transfer to lateral column (H) (Anaes.) (Assist.)
561.55
50342
Foot and ankle, tibialis or tibialis posterior tendon transfer, through the interosseous membrane to anterior or posterior aspect of foot (H) (Anaes.) (Assist.)
651.60
50345
Hyperextension deformity of toe, release incorporating V‑Y plasty of skin, lengthening of extensor tendons and release of capsule contracture (H) (Anaes.) (Assist.)
346.65
50348
Knee, deformity of, post‑operative manipulation and change of plaster, performed under general anaesthesia in the operating theatre of a hospital (Anaes.)
228.70
50349
Hip, congenital dislocation of, treatment of, by closed reduction (Anaes.) (Assist.)
320.15
50351
Hip, developmental dislocation of, open reduction of (H) (Anaes.) (Assist.)
1 597.25
50352
Hip, congenital dislocation of, treatment of, involving supervision of splint, harness or cast—each attendance (Anaes.)
56.50
50353
Hip spica, initial application of, for congenital dislocation of hip (excluding after‑care) (H) (Anaes.) (Assist.)
354.80
50354
Tibia, pseudarthrosis of, congenital, resection and internal fixation (Anaes.) (Assist.)
1 310.15
50357
Knee, leg or thigh, rectus femoris tendon transfer or medial or lateral hamstring tendon transfer (H) (Anaes.) (Assist.)
561.55
50360
Knee, leg or thigh, combined medial and lateral hamstring tendon transfer (H) (Anaes.) (Assist.)
651.60
50363
Knee, contracture of, posterior release involving multiple tendon lengthening or tenotomies, unilateral (H) (Anaes.) (Assist.)
499.05
50366
Knee, contracture of, posterior release involving multiple tendon lengthening or tenotomies, bilateral (H) (Anaes.) (Assist.)
873.45
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.)
651.60
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.)
1 143.80
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.)
499.05
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.)
873.45
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.)
651.60
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.)
1 143.80
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.)
651.60
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 (Anaes.)
228.70
50393
Pelvis, bone graft or shelf procedures for acetabular dysplasia (H) (Anaes.) (Assist.)
845.60
50394
Acetabular dysplasia, treatment of, by multiple peri‑acetabular osteotomy, including internal fixation, if performed (H) (Anaes.) (Assist.)
2 777.30
50396
Hand, congenital abnormalities or duplication of digits, amputation or splitting of phalanx or phalanges, with ligament or joint reconstruction (H) (Anaes.) (Assist.)
464.55
50399
Forearm, radial aplasia or dysplasia (radial club hand), centralisation or radialisation of (H) (Anaes.) (Assist.)
922.05
50402
Torticollis, bipolar release of sternocleidomastoid muscle and associated soft tissue (H) (Anaes.) (Assist.)
422.95
50405
Elbow, flexorplasty, or tendon transfer to restore elbow function (H) (Anaes.) (Assist.)
575.40
50408
Shoulder, congenital or developmental dislocation, open reduction of (H) (Anaes.) (Assist.)
998.25
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.)
1 310.15
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.)
1 767.60
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.)
1 310.15
50420
Patella, congenital dislocation of, reconstruction of the quadriceps (H) (Anaes.) (Assist.)
1 081.35
50423
Tibia, fibula or both, congenital deficiency of, transfer of the fibula to tibia, with internal fixation (Anaes.) (Assist.)
998.25
50426
Diaphyseal aclasia, removal of lesion or lesions from bone—one approach (H) (Anaes.) (Assist.)
464.55
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.)
1 226.90
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.)
1 226.90
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.)
1 389.40
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.)
1 389.40
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.)
2 074.45
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.)
2 074.45
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.)
2 921.80
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.)
2 921.80
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.)
3 705.55
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.)
3 705.55
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.)
4 275.85
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.)
4 275.85
50500
Radius or ulna, distal end of, with open growth plate, treatment of fracture of, by closed reduction (Anaes.)
276.65
50504
Radius or ulna, distal end of, with open growth plate, treatment of fracture of, by open reduction (Anaes.) (Assist.)
369.05
50508
Radius, distal end of, with open growth plate, treatment of Colles’, Smith’s or Barton’s fracture of, by closed reduction (Anaes.)
395.25
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.)
527.30
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 (Anaes.)
355.85
50520
Radius or ulna, shaft of, with open growth plate, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
474.40
50524
Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by closed reduction undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
408.50
50528
Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by reduction with or without internal fixation by open or percutaneous means (H) (Anaes.) (Assist.)
659.00
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.)
573.40
50536
Radius and ulna, shafts of, with open growth plates, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
764.40
50540
Olecranon, with open growth plate, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
527.30
50544
Radius, with open growth plate, treatment of fracture of head or neck of, by closed reduction of (Anaes.)
263.60
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.)
527.30
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 (Anaes.)
454.75
50556
Humerus, proximal, with open growth plate, treatment of fracture of, by open reduction (H) (Anaes.) (Assist.)
606.20
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.)
474.40
50564
Humerus, shaft of, with open growth plate, treatment of fracture of, by internal or external fixation (H) (Anaes.) (Assist.)
632.65
50568
Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
553.60
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.)
738.10
50576
Femur, with open growth plate, treatment of fracture of, by closed reduction or traction (Anaes.) (Assist.)
606.20
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.)
632.65
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.)
606.20
50588
Tibia and fibula, with open growth plates, treatment of fracture of, by internal fixation (H) (Anaes.) (Assist.)
790.70
50600
Scoliosis or kyphosis, in a child, manipulation of deformity and application of a localiser cast, under general anaesthesia, in a hospital (Anaes.) (Assist.)
434.70
50604
Scoliosis or kyphosis, in a child or adolescent, spinal fusion for (without instrumentation) (H) (Anaes.) (Assist.)
1 845.05
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 48642 to 48675 apply (H) (Anaes.) (Assist.)
3 426.95
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 48642 to 48675 apply (H) (Anaes.) (Assist.)
4 874.50
50616
Scoliosis, in a child or adolescent, re‑exploration for adjustment or removal of segmental instrumentation used for correction of spine deformity (H) (Anaes.) (Assist.)
619.35
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 48642 to 48675 apply (H) (Anaes.) (Assist.)
3 426.95
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.)
3 426.95
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.)
4 233.20
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 48642 to 48675 apply (H) (Anaes.) (Assist.)
3 558.65
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 48642 to 48675 apply (H) (Anaes.) (Assist.)
3 954.10
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 48642 to 48675 apply (H) (Anaes.) (Assist.)
2 185.80
50644
Spine, bone graft to, for a child or adolescent, associated with surgery for correction of scoliosis or kyphosis or both (H) (Anaes.) (Assist.)
2 108.95
50650
Hip dysplasia or dislocation, in a child, examination, manipulation and arthrography of the hip under anaesthesia (Anaes.)
414.75
50654
Hip dysplasia or dislocation, in a child, application or reapplication of a hip spica, including examination of the hip (H) (Assist.) (Anaes.)
496.65
50658
Hip dysplasia or dislocation, in a child, examination and manipulation of the hip under anaesthesia (Anaes.)
197.75
Subgroup 16—Radiofrequency ablation
50950
Nonresectable hepatocellular carcinoma, destruction of, by percutaneous radiofrequency ablation, including any associated imaging services, other than a service associated with a service to which item 30419 or 50952 applies (Anaes.)
817.10
50952
Nonresectable hepatocellular carcinoma, destruction of, by open or laparoscopic radiofrequency ablation, if a multi‑disciplinary team has assessed that percutaneous radiofrequency 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 procedure;
(c) resection of one part of the liver is possible, however there is at least one primary liver tumour in a nonresectable section of the liver that is suitable for radiofrequency ablation;
including any associated imaging services, other than a service associated with a service to which item 30419 or 50950 applies (Anaes.)
817.10
Division 2.45—Group T9: Assistance at operations
2.45.1 Meaning of amount under clause 2.45.1
In item 51303:
amount under clause 2.45.1, 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.
2.45.2 Meaning of amount under clause 2.45.2
In item 51309:
amount under clause 2.45.2, 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.
2.45.3 Meaning of amount under clause 2.45.3
In item 51312:
amount under clause 2.45.3, 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.
2.45.4 Meaning of previous significant surgical complication
In item 51318:
previous significant surgical complication means:
(a) vitreous loss; or
(b) rupture of posterior capsule; or
(c) loss of nuclear material into the vitreous; or
(d) intraocular haemorrhage; or
(e) intraocular infection (endophthalmitis); or
(f) cystoid macular oedema; or
(g) corneal decompensation; or
(h) retinal detachment.
2.45.5 Application of Group T9
Items 51300 to 51318 do 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 post‑surgical pain management.
2.45.6 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.
Group T9—Assistance at operations
Item
Description
Fee ($)
51300
Assistance at any operation mentioned in an item in Group T8 that includes “(Assist.)” for which the fee does not exceed $558.30 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 $558.30
86.30
51303
Assistance at any operation mentioned in an item in Group T8 that includes “(Assist.)” for which the fee exceeds $558.30 or at a series or combination of operations mentioned in an item in Group T8 that include “(Assist.)” for which the aggregate fee exceeds $558.30
Amount under clause 2.45.1
51306
Assistance at a delivery involving Caesarean section
124.65
51309
Assistance at a series or combination of operations that include “(Assist.)” and assistance at a delivery involving Caesarean section
Amount under clause 2.45.2
51312
Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615, 16627 and 16633
Amount under clause 2.45.3
51315
Assistance at cataract and intraocular lens surgery covered by item 42698, 42701, 42702, 42704 or 42707, when performed in association with services covered by item 42551 to 42569, 42653, 42656, 42725, 42746, 42749, 42752, 42776 or 42779
272.40
51318
Assistance at cataract and intraocular lens surgery, if patient has:
(a) total loss of vision, including no potential for central vision, in the fellow eye; or
(b) previous significant surgical complication in the fellow eye; or
(c) pseudo exfoliation, subluxed lens, iridodonesis, phacodonesis, retinal detachment, corneal scarring, pre‑existing uveitis, bound down miosed pupil, nanophthalmos, spherophakia, Marfan’s syndrome, homocysteinuria or previous blunt trauma causing intraocular damage
179.75
Division 2.46—Oral and Maxillofacial services
2.46.1 Application of Groups O1 to O11
Items 51700 to 53706 apply only to a service provided in the course of dental practice by a dental practitioner approved by the Minister before 1 November 2004 for the definition of professional service in subsection 3(1) of the Act.
Division 2.47—Group O1: Consultations
Group O1—Consultations
Item
Description
Fee ($)
51700
Professional attendance (other than a second or subsequent attendance in a single course of treatment) by an approved dental practitioner in the practice of oral and maxillofacial surgery, at consulting rooms, hospital or residential aged care facility if the patient is referred to him or her
85.55
51703
Professional attendance by an approved dental practitioner in the practice of oral and maxillofacial surgery, each attendance after the first in a single course of treatment at consulting rooms, hospital or residential aged care facility if the patient is referred to him or her
43.00
Division 2.48—Group O2: Assistance at operation
2.48.1 Meaning of amount under clause 2.48.1
In item 51803:
amount under clause 2.48.1, 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.
2.48.2 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.
Group O2—Assistance at operation
Item
Description
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 $558.30 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 $558.30
86.30
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 $558.30 or at a series or combination of operations mentioned in an item that include “(Assist.)” if the aggregate fee exceeds $558.30
Amount under clause 2.48.1
Division 2.49—Group O3: General surgery
Group O3—General surgery
Item
Description
Fee ($)
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.)
326.05
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.)
73.90
51904
Lipectomy—wedge excision of skin or fat—one excision (Anaes.) (Assist.)
454.85
51906
Lipectomy—wedge excision of skin or fat—2 or more excisions (Anaes.) (Assist.)
691.75
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.)
82.50
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.)
117.55
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.)
117.55
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.)
185.60
52010
Full thickness laceration of ear, eyelid, nose or lip, repair of, with accurate apposition of each layer of tissue (Anaes.) (Assist.)
254.00
52012
Superficial foreign body, removal of, as an independent procedure (Anaes.)
23.50
52015
Subcutaneous foreign body, removal of, requiring incision and suture, as an independent procedure (Anaes.)
109.90
52018
Foreign body in muscle, tendon or other deep tissue, removal of, as an independent procedure (Anaes.) (Assist.)
276.80
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.)
29.45
52024
Biopsy of skin or mucous membrane, as an independent procedure (Anaes.)
52.20
52025
Lymph node of neck, biopsy of (Anaes.)
183.90
52027
Biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure and other than a service to which item 52025 applies (Anaes.)
149.75
52030
Sinus, excision of, involving superficial tissue only (Anaes.)
90.00
52033
Sinus, excision of, involving muscle and deep tissue (Anaes.)
183.90
52034
Premalignant lesions of the oral mucous, treatment by cryotherapy, diathermy or carbon dioxide laser
43.00
52035
Endoscopic laser therapy for neoplasia and benign vascular lesions of the oral cavity (Anaes.)
476.10
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.)
126.90
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.)
326.05
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.)
172.50
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.)
246.50
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.)
371.50
52051
Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (Anaes.) (Assist.)
502.25
52054
Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (Anaes.) (Assist.)
587.60
52055
Haematoma, small abscess or cellulitis in the oral and maxillofacial region, not requiring admission to a hospital, incision with drainage of (excluding after‑care)
27.35
52056
Haematoma in the oral and maxillofacial region, aspiration of (Anaes.)
27.35
52057
Large haematoma, large abscess, carbuncle, cellulitis or similar lesion in the oral and maxillofacial region, incision with drainage of (excluding after‑care) (H) (Anaes.)
162.95
52058
Percutaneous drainage of deep abscess in the oral and maxillofacial region, using interventional imaging techniques—but not including imaging (Anaes.)
237.60
52059
Abscess in the oral and maxillofacial region drainage tube, exchange of using interventional imaging techniques—but not including imaging (Anaes.)
267.65
52060
Muscle in the oral and maxillofacial region, excision of (Anaes.)
189.40
52061
Muscle, in the oral and maxillofacial region, ruptured, repair of (limited), not associated with external wound (Anaes.)
223.60
52062
Muscle, in the oral and maxillofacial region, ruptured, repair of (extensive), not associated with external wound (Anaes.) (Assist.)
295.70
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.)
356.35
52064
Bone cyst in the oral and maxillofacial region, injection into or aspiration of (Anaes.)
169.50
52066
Submandibular gland, extirpation of (Anaes.) (Assist.)
445.40
52069
Sublingual gland, extirpation of (Anaes.)
198.50
52072
Salivary gland, dilatation or diathermy of duct (Anaes.)
58.80
52073
Salivary gland, repair of cutaneous fistula of (Anaes.)
149.75
52075
Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, one or more such procedures (Anaes.)
149.75
52078
Tongue, partial excision of (Anaes.) (Assist.)
295.70
52081
Tongue tie, division or excision of frenulum (Anaes.)
46.50
52084
Tongue tie, mandibular frenulum or maxillary frenulum, division or excision of frenulum, in a person aged not less than 2 years (Anaes.)
119.50
52087
Ranula or mucous cyst of mouth, removal of (Anaes.)
204.70
52090
Operation on mandible or maxilla (other than alveolar margins) for chronic osteomyelitis—one bone or in combination with adjoining bones (Anaes.) (Assist.)
356.35
52092
Operation on skull for osteomyelitis (Anaes.) (Assist.)
464.50
52094
Operation on any combination of adjoining bones in the oral and maxillofacial region, being bones referred to in item 52092 (Anaes.) (Assist.)
587.55
52095
Bone growth stimulator in the oral and maxillofacial region, insertion of (Anaes.) (Assist.)
380.80
52096
Orthopaedic pin or wire, insertion of, into maxilla or mandible or zygoma, as an independent procedure (Anaes.)
112.85
52097
External fixation in the oral and maxillofacial region, removal of, in the operating theatre of a hospital (Anaes.)
160.05
52098
External fixation in the oral and maxillofacial region, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)
188.20
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.)
141.25
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.)
141.25
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.)
263.60
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 (Anaes.)
108.90
52108
Lip, full thickness wedge excision of, with repair by direct sutures (Anaes.) (Assist.)
326.05
52111
Vermilionectomy (Anaes.) (Assist.)
326.05
52114
Mandible or maxilla, segmental resection of, for tumours or cysts (Anaes.) (Assist.)
587.60
52117
Mandible, including lower border, or maxilla, sub‑total resection of (Anaes.) (Assist.)
699.45
52120
Mandible, hemimandiblectomy of, including condylectomy, if performed (Anaes.) (Assist.)
827.30
52122
Mandible, hemi‑mandibular 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.)
827.30
52123
Mandible, total resection of both sides, including condylectomies if performed (Anaes.) (Assist.)
936.55
52126
Maxilla, total resection of (Anaes.) (Assist.)
900.45
52129
Maxilla, total resection of both maxillae (Anaes.) (Assist.)
1 205.40
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.)
442.45
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.)
611.90
52132
Tracheostomy (Anaes.)
248.95
52133
Cricothyrostomy by direct stab or Seldinger technique, using mini tracheostomy device (Anaes.)
91.05
52135
Post‑operative or post‑nasal haemorrhage, or both, control of, if undertaken in the operating theatre of a hospital (Anaes.)
144.35
52138
Maxillary artery, ligation of (Anaes.) (Assist.)
448.55
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.)
443.70
52144
Foreign body, deep, removal of using interventional imaging techniques (Anaes.) (Assist.)
413.55
52147
Duct of major salivary gland, transposition of (Anaes.) (Assist.)
390.25
52148
Parotid duct, repair of, using micro‑surgical techniques (Anaes.) (Assist.)
689.80
52158
Submandibular ducts, relocation of, for surgical control of drooling (Anaes.) (Assist.)
1 110.65
52180
Aggressive or potentially malignant bone or deep soft tissue tumour in the oral and maxillofacial region, biopsy of (not including after‑care) (Anaes.)
188.20
52182
Bone or malignant deep soft tissue tumour in the oral and maxillofacial region, lesional or marginal excision of (Anaes.) (Assist.)
414.25
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.)
611.90
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.)
753.25
Division 2.50—Group O4: Plastic and reconstructive
2.50.1 Meaning of maxilla
In items 52342 to 52375, maxilla includes the zygoma.
Group O4—Plastic and reconstructive
Item
Description
Fee ($)
52300
Single‑stage local flap, where indicated, repair to one defect, with skin or mucosa (Anaes.) (Assist.)
284.35
52303
Single‑stage local flap, if indicated, repair to one defect, with buccal pad of fat (Anaes.) (Assist.)
406.05
52306
Single‑stage local flap, if indicated, repair to one defect, using temporalis muscle (Anaes.) (Assist.)
602.45
52309
Free grafting (mucosa or split skin) of a granulating area (Anaes.)
204.70
52312
Free grafting (mucosa, split skin or connective tissue) to one defect, including elective dissection (Anaes.) (Assist.)
284.35
52315
Free grafting, full thickness, to one defect (mucosa or skin) (Anaes.) (Assist.)
473.75
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.)
141.25
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.)
235.50
52321
Foreign implant (non‑biological), insertion of, for contour reconstruction of pathological deformity, other than a service associated with a service to which item 52624 applies (Anaes.) (Assist.)
473.75
52324
Direct flap repair, using tongue, first stage (Anaes.) (Assist.)
473.75
52327
Direct flap repair, using tongue, second stage (Anaes.)
235.05
52330
Palatal defect (oro‑nasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (Anaes.) (Assist.)
781.95
52333
Cleft palate, primary repair (Anaes.) (Assist.)
781.95
52336
Cleft palate, secondary repair, closure of fistula using local flaps (Anaes.) (Assist.)
488.75
52337
Alveolar cleft (congenital) unilateral, grafting of, including plastic closure of associated oro‑nasal fistulae and ridge augmentation (Anaes.) (Assist.)
1 069.10
52339
Cleft palate, secondary repair, lengthening procedure (Anaes.) (Assist.)
556.60
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.)
966.80
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.)
1 090.35
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.)
1 232.05
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.)
1 383.65
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.)
1 402.70
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.)
1 579.20
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.)
1 611.05
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.)
1 812.40
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.)
1 772.30
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.)
1 992.70
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.)
1 933.55
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.)
2 165.75
52378
Genioplasty including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
748.65
52379
Face, contour reconstruction of one region, using autogenous bone or cartilage graft (Anaes.) (Assist.)
1 279.45
52380
Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar‑Maxillary), 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.)
2 178.60
52382
Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar‑Maxillary), 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.)
2 611.60
52420
Mandible, fixation by intermaxillary wiring, excluding wiring for obesity
241.15
52424
Dermis, dermofat or fascia graft (excluding transfer of fat by injection) in the oral and maxillofacial region (Anaes.) (Assist.)
473.65
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.)
1 090.35
52440
Cleft lip, unilateral—primary repair, one stage, without anterior palate repair (Anaes.) (Assist.)
541.35
52442
Cleft lip, unilateral—primary repair, one stage, with anterior palate repair (Anaes.) (Assist.)
676.80
52444
Cleft lip, bilateral—primary repair, one stage, without anterior palate repair (Anaes.) (Assist.)
751.85
52446
Cleft lip, bilateral—primary repair, one stage, with anterior palate repair (Anaes.) (Assist.)
887.50
52450
Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)
300.75
52452
Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes.) (Assist.)
488.75
52456
Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)
827.30
52458
Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)
300.75
52460
Velo‑pharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (Anaes.)
781.95
52480
Composite graft (chondro‑cutaneous or chondro‑mucosal) to nose, ear or eyelid (Anaes.) (Assist.)
502.25
52482
Macrocheilia or macroglossia, operation for (Anaes.) (Assist.)
483.25
52484
Macrostomia, operation for (Anaes.) (Assist.)
575.30
Division 2.51—Group O5: Preprosthetic
Group O5—Preprosthetic
Item
Description
Fee ($)
52600
Mandibular or palatal exostosis, excision of (Anaes.) (Assist.)
338.35
52603
Mylohyoid ridge, reduction of (Anaes.) (Assist.)
323.40
52606
Maxillary tuberosity, reduction of (Anaes.)
246.70
52609
Papillary hyperplasia of the palate, removal of—less than 5 lesions (Anaes.) (Assist.)
323.40
52612
Papillary hyperplasia of the palate, removal of—5 to 20 lesions (Anaes.) (Assist.)
406.05
52615
Papillary hyperplasia of the palate, removal of—more than 20 lesions (Anaes.) (Assist.)
503.85
52618
Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed—unilateral or bilateral (Anaes.) (Assist.)
586.50
52621
Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed—unilateral (Anaes.) (Assist.)
586.50
52624
Alveolar ridge augmentation with bone or alloplast or both—unilateral (Anaes.) (Assist.)
473.65
52626
Alveolar ridge augmentation—unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes.) (Assist.)
290.50
52627
Osseo‑integration procedure—extra oral implantation of titanium fixture (Anaes.) (Assist.)
503.85
52630
Osseo‑integration procedure—fixation of transcutaneous abutment (Anaes.)
186.50
52633
Osseo‑integration procedure—intra‑oral 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.)
503.85
52636
Osseo‑integration procedure—fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)
186.50
Division 2.52—Group O6: Neurosurgical
Group O6—Neurosurgical
Item
Description
Fee ($)
52800
Neurolysis by open operation, without transposition, other than a service associated with a service to which item 52803 applies (Anaes.) (Assist.)
276.80
52803
Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (Anaes.) (Assist.)
398.55
52806
Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (Anaes.) (Assist.)
276.80
52809
Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (Anaes.) (Assist.)
473.75
52812
Nerve trunk, primary repair of, using microsurgical techniques (Anaes.) (Assist.)
676.80
52815
Nerve trunk, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)
714.35
52818
Nerve, transposition of (Anaes.) (Assist.)
473.75
52821
Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes.) (Assist.)
1 030.20
52824
Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (Anaes.) (Assist.)
443.70
52826
Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes.)
237.60
52828
Cutaneous nerve, primary repair of, using microsurgical techniques (Anaes.) (Assist.)
353.35
52830
Cutaneous nerve, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)
466.10
52832
Cutaneous nerve, nerve graft to, using microsurgical techniques (Anaes.) (Assist.)
639.20
Division 2.53—Group O7: Ear, nose and throat
Group O7—Ear, nose and throat
Item
Description
Fee ($)
53000
Maxillary antrum, proof puncture and lavage of (Anaes.)
32.55
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.)
91.90
53004
Maxillary antrum, lavage of—each attendance at which the procedure is performed, including any associated consultation (Anaes.)
35.60
53006
Antrostomy (radical) (Anaes.) (Assist.)
521.25
53009
Antrum, intranasal operation on or removal of foreign body from (Anaes.) (Assist.)
295.70
53012
Antrum, drainage of, through tooth socket (Anaes.)
117.55
53015
Oro‑antral fistula, plastic closure of (Anaes.) (Assist.)
587.60
53016
Nasal septum, septoplasty, submucous resection or closure of septal perforation (Anaes.) (Assist.)
483.25
53017
Nasal septum, reconstruction of (Anaes.) (Assist.)
602.85
53019
Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes.) (Assist.)
580.90
53052
Post‑nasal space, direct examination of, with or without biopsy (Anaes.)
122.85
53054
Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx—one or more of these procedures (Anaes.)
122.85
53056
Examination of nasal cavity or post‑nasal space, or nasal cavity and post‑nasal space, under general anaesthesia, other than a service associated with a service to which another item in this Group applies (Anaes.)
71.95
53058
Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding after‑care) (Anaes.)
122.85
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.)
100.50
53062
Post‑surgical nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)
90.00
53064
Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes.)
162.95
53068
Turbinectomy or turbinectomies, partial or total, unilateral (Anaes.)
136.50
53070
Turbinates, submucous resection of, unilateral (Anaes.)
178.05
Division 2.54—Group O8: Temporomandibular joint
Group O8—Temporomandibular joint
Item
Description
Fee ($)
53200
Mandible, treatment of a dislocation of, not requiring open reduction (Anaes.)
70.65
53203
Mandible, treatment of a dislocation of, requiring open reduction (Anaes.)
118.70
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 (Anaes.)
142.95
53209
Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (Anaes.) (Assist.)
1 649.10
53212
Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)
890.85
53215
Temporomandibular joint, arthroscopy of, with or without biopsy, other than a service associated with another arthroscopic procedure of that joint (Anaes.) (Assist.)
408.70
53218
Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions—one or more of such procedures (Anaes.) (Assist.)
653.80
53220
Temporomandibular joint, arthrotomy of, other than a service to which another item in this Group applies (Anaes.) (Assist.)
329.60
53221
Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)
872.30
53224
Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)
967.00
53225
Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space (Anaes.) (Assist.)
290.50
53226
Temporomandibular joint, synovectomy of, other than a service to which another item in this Group applies (Anaes.) (Assist.)
312.30
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.)
1 188.20
53230
Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)
1 338.45
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.)
1 504.05
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.)
470.70
53239
Temporomandibular joint, arthrodesis of, other than a service to which another item in this Group applies (Anaes.) (Assist.)
470.70
53242
Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)
312.30
Division 2.55—Group O9: Treatment of fractures
Group O9—Treatment of fractures
Item
Description
Fee ($)
53400
Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting
129.20
53403
Mandible, treatment of fracture of, not requiring splinting
157.85
53406
Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)
406.65
53409
Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)
406.65
53410
Zygomatic bone, treatment of fracture of, not requiring surgical reduction
85.65
53411
Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra‑oral or other approach (Anaes.)
238.80
53412
Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at one site (Anaes.) (Assist.)
392.10
53413
Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.)
480.35
53414
Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.)
551.85
53415
Maxilla, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)
435.65
53416
Mandible, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)
435.65
53418
Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)
566.35
53419
Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)
566.35
53422
Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.)
718.75
53423
Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.)
718.75
53424
Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.)
616.65
53425
Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.)
616.65
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.)
842.25
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.)
842.25
53439
Mandible, treatment of a closed fracture of, involving a joint surface (Anaes.)
238.80
53453
Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes.) (Assist.)
483.25
53455
Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.)
567.65
53458
Nasal bones, treatment of fracture of, other than a service to which item 53459 or 53460 applies
43.05
53459
Nasal bones, treatment of fracture of, by reduction (Anaes.)
235.50
53460
Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes.) (Assist.)
480.35
Division 2.56—Group O10: Diagnostic procedures and investigations
Group O10—Diagnostic procedures and investigations
Item
Description
Fee ($)
53600
Skin sensitivity testing for allergens to anaesthetics and materials used in oral and maxillofacial surgery, using one to 20 allergens
38.95
Division 2.57—Group O11: Regional or field nerve blocks
Group O11—Regional or field nerve blocks
Item
Description
Fee ($)
53700
Trigeminal nerve, primary division of, injection of an anaesthetic agent
124.85
53702
Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent
62.50
53704
Facial nerve, injection of an anaesthetic agent
37.65
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
124.85
Part 3—Dictionary
Note: All references in the Dictionary to a provision are references to a provision in this Schedule of this instrument unless otherwise indicated.
In this instrument:
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.
ACRRM means the Australian College of Rural and Remote Medicine.
Act means the Health Insurance Act 1973.
after‑hours 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.
amount under clause 2.1.1 has the meaning given by clause 2.1.1.
amount under clause 2.20.2 has the meaning given by clause 2.20.2.
amount under clause 2.38.1 has the meaning given by clause 2.38.1.
amount under clause 2.40.2 has the meaning given by clause 2.40.2.
amount under clause 2.42.1 has the meaning given by clause 2.42.1.
amount under clause 2.43.1 has the meaning given by clause 2.43.1.
amount under clause 2.43.2 has the meaning given by clause 2.43.2.
amount under clause 2.44.4 has the meaning given by clause 2.44.4.
amount under clause 2.44.5 has the meaning given by clause 2.44.5.
amount under clause 2.44.18 has the meaning given by clause 2.44.18.
amount under clause 2.45.1 has the meaning given by clause 2.45.1.
amount under clause 2.45.2 has the meaning given by clause 2.45.2.
amount under clause 2.45.3 has the meaning given by clause 2.45.3.
amount under clause 2.48.1 has the meaning given by clause 2.48.1.
approved site:
(a) for item 15338—has the meaning given by clause 2.38.2; and
(b) for items 37220 and 37227—has the meaning given by clause 2.44.1.
ASGC, for Division 2.31, has the meaning given by clause 2.31.1.
associated medical practitioner:
(a) for item 732—has the meaning given by clause 2.17.2; and
(b) for item 2712—has the meaning given by clause 2.20.5.
bulk‑billed:
(a) for items 10931, 10932 and 10933—has the meaning given by subclause 2.28.4(3); and
(b) for Division 2.31—has the meaning given by clause 2.31.1.
care recipient means a person receiving residential care under section 21‑2 of the Aged Care Act 1997.
case conference team, for item 880, has the meaning given by clause 2.17.17.
closed reduction means treatment of a dislocation or fracture by non‑operative reduction, including the use of percutaneous fixation, or external splintage by cast or splints.
Commonwealth concession card holder, for Division 2.31, has the meaning given by clause 2.31.1.
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.
complex paediatric case, for item 25205, has the meaning given by clause 2.43.3.
comprehensive hyperbaric medicine facility, for items 13015, 13020, 13025 and 13030, has the meaning given by clause 2.37.1.
contribute to a multidisciplinary care plan, for items 729 and 731, has the meaning given by clause 2.17.3.
coordinating, for item 880, has the meaning given by clause 2.17.16.
coordinating a review of team care arrangements, for item 732, has the meaning given by clause 2.17.5.
coordinating the development of team care arrangements, for item 723, has the meaning given by clause 2.17.4.
delivery, for items 16515, 16519, 16522, 16527, 16590 and 16591, has the meaning given by clause 2.40.3.
eligible allied health provider:
(a) for items 135, 137 and 139—has the meaning given by clause 2.5A.1; and
(b) for item 289—has the meaning given by clause 2.10.5.
eligible area, for Division 2.31, has the meaning given by clause 2.31.1.
eligible disability has the meaning given by clause 2.5A.2.
eligible non‑vocationally recognised medical practitioner has the meaning given by clause 1.1.1.
embryology laboratory services, for items 13200, 13201 and 13206, has the meaning given by clause 2.37.2.
family carer, of a patient, includes a person if the person is:
(a) a relative or friend of the patient; and
(b) providing care to the patient other than for payment.
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 2.44.13.
(G) has the meaning given by clause 1.1.5.
general intensive care unit means a separate hospital area 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 the meaning given by clause 1.1.1A.
GP management plan, for item 10997, has the meaning given by clause 2.30.1.
(H) has the meaning given by clause 1.1.6.
immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.
immunisation recommended for a 4 year old child means the immunisation recommended for a 4 year old child by the National Immunisation Program Schedule as in effect on 1 July 2013.
Note: The National Immunisation Program Schedule could in 2015 be viewed on the Department’s website (http://www.immunise.health.gov.au).
institution means a place (other than a hospital or residential aged care facility) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or intellectually disabled persons.
intensive care unit means a general intensive care unit or a neo‑natal intensive care unit.
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 2; or
(ii) Part 2 of the diagnostic imaging services table; or
(iii) Part 2 of the pathology services table; and
(b) in a reference immediately followed by a number—the item so numbered.
Note: Because of the determination about allied health services under subsection 3C(1) of the Act, certain health services are treated as if there were an item for the service mentioned in the table. A note is included at the end of a provision of this instrument if an item mentioned in the provision is that kind of item: see subclause 2.20.3(2) for an example.
living in a community setting, for item 900, has the meaning given by clause 2.18.1.
maxilla:
(a) for items 45720 to 45752—has the meaning given by clause 2.44.19; and
(b) for items 52342 to 52375—has the meaning given by clause 2.50.1.
mental disorder, for Division 2.20, 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.
multidisciplinary care plan:
(a) for items 729 and 731—has the meaning given by clause 2.17.6; and
(b) for item 10997—has the meaning given by clause 2.30.1.
multidisciplinary case conference has the meaning given by clause 1.1.2.
multidisciplinary case conference in a residential aged care facility, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.17.13.
multidisciplinary case conference team has the meaning given by clause 1.1.3.
multidisciplinary discharge case conference, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.17.12.
neo‑natal 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.
non‑directive pregnancy support counselling, for item 4001, has the meaning given by clause 2.22.1.
non‑medicare service means any of the following:
(a) endoluminal gastroplication, for the treatment of gastro‑oesophageal reflux disease;
(b) gamma knife surgery;
(c) intradiscal electro thermal arthroplasty;
(d) intravascular ultrasound, except if used in conjunction with intravascular brachytherapy;
(e) intro‑articular 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 matrix‑induced autologous chondrocyte implantation;
(o) vertebroplasty.
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) non‑operative (closed) reduction using intra‑medullary 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 2.17.14; and
(b) for items mentioned in Subgroups 2 and 4 of Group A24—has the meaning given by clause 2.21.1.
outcome measurement tool, for Division 2.20, 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 2.17.15; 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.
participating in a video conferencing consultation has the meaning given by clause 1.2.9.
patient’s medical condition requires urgent treatment, for items 597 to 600, has the meaning given by clause 2.15.1.
patient’s usual medical practitioner means a medical 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 2.30.1.
pharmaceutical benefits scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.
practice location has the meaning given by clause 2.31.1.
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.
preparing a GP management plan, for item 721, has the meaning given by clause 2.17.7.
previous significant surgical complication, for item 51318, has the meaning given by clause 2.45.4.
problem focussed history, for items 501, 503 and 507, has the meaning given by clause 2.14.2.
qualified medical acupuncturist has the meaning given by clause 2.9.1.
qualified radiologist, for item 31542, has the meaning given by clause 2.44.7.
qualified sleep medicine practitioner:
(a) for items 12203, 12207, 12213 and 12217—has the meaning given by subclause 2.34.2(1); and
(b) for items 12210 and 122015—has the meaning given by subclause 2.34.2(1A); and
(c) for item 12250—has the meaning given by subclause 2.34.2(1AA).
qualified surgeon, for items 31539 and 31545, has the meaning given by clause 2.44.6.
RACGP means the Royal Australian College of General Practitioners.
recognised emergency department, for Division 2.14, has the meaning given by clause 2.14.1.
referral means referral by a referring practitioner.
referring practitioner, for the referral of a patient, means:
(a) for all referrals—a medical practitioner; or
(b) for a referral made to a specialist who is an ophthalmologist—an optometrist; or
(c) for a referral that arises out of a dental service provided by a dental practitioner and that is made to a specialist (but not a consultant physician)—a dental practitioner; or
(d) for a referral that arises out of a dental service provided by a dental practitioner who is approved by the Minister for the purposes of paragraph (b) of the definition of professional service in subsection 3(1) of the Act and that is made to a consultant physician—a dental practitioner; or
(e) for a referral made to a specialist in the specialty of obstetrics or paediatrics (however described) that arises out of a midwifery service provided by a participating midwife—a participating midwife; or
(f) for a referral made to a specialist or consultant physician that arises out of a nurse practitioner service provided by a participating nurse practitioner—a participating nurse practitioner.
regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.
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.
report, for Division 2.34, has the meaning given by clause 2.34.1.
residential aged care facility means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.
residential care service has the meaning given by clause 1 of Schedule 1 to the Aged Care Act 1997.
residential medication management review, for item 903, has the meaning given by clause 2.18.2.
responsible person, for items 597 to 600, has the meaning given by clause 2.15.2.
reviewing a GP management plan, for item 732, has the meaning given by clause 2.17.8.
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 2.5A.1; and
(b) for item 289—has the meaning given by clause 2.10.5.
Rural, Remote and Metropolitan Areas Classification means the document so titled, as in force on 1 January 2001, 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.
(S) has the meaning given by clause 1.1.7.
service time, for an item in subgroups 21, 24, 25 and 26 of Group T10, has the meaning given by clause 2.43.4.
single course of treatment has the meaning given by clause 1.1.4.
SLA, for Division 2.31, has the meaning given by clause 2.31.1.
SSD, for Division 2.31, has the meaning given by clause 2.31.1.
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.
Note: Maps showing telehealth eligible areas could in 2015 be viewed on the Department’s Medicare Benefits Schedule website (http://www.mbsonline.gov.au).
treatment cycle, for clause 2.37.4 and items 13200 to 13209, 13215 and 13218, has the meaning given by clause 2.37.3.
unreferred service, for Division 2.31, has the meaning given by clause 2.31.1.
unsociable hours means the period starting at 11 pm and ending at 7 am on any day.
Schedule 2—Repeals
Health Insurance (General Medical Services Table) Regulation 2014
1 The whole of the regulation
Repeal the regulation.
