Health Insurance (Botulinum Toxin for Urinary Incontinence due to Neurogenic Detrusor Overactivity) Determination 2013 (No.2)
Health Insurance Act 1973
I, RICHARD BARTLETT, First Assistant Secretary, Medical Benefits Division, Department of Health, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.
Dated 24th October 2013
First Assistant Secretary
Medical Benefits Division
Department of Health
1 Name of determination 3
2 Commencement 3
3 Cessation 3
4 Authority 3
5 Interpretation 3
6 Treatment of a relevant service 3
7 Application of specified provisions of the general medical services table 3
Schedule 1 Specified Health Services 4
1 Name of determination
This determination is the Health Insurance (Botulinum Toxin for Urinary Incontinence due to Neurogenic Detrusor Overactivity) Determination 2013 (No.2).
This determination commences on 1 November 2013.
This determination ceases as if repealed on the cessation or earlier repeal of the Health Insurance (General Medical Services Table) Regulation 2012.
This determination is made under the Health Insurance Act 1973.
(1) In this determination:
Act means the Health Insurance Act 1973.
relevant provisions means all provisions of the Act and regulations made under the Act and the National Health Act 1953 and all regulations under that Act, relating to professional services, medical services or items.
relevant service means a health service specified in an item in the Schedule to this determination.
6 Treatment of a relevant service
A relevant service provided in accordance with this determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in Group T11 of the general medical services table that:
i. related to the service; and
ii. specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
7 Application of specified provisions of the general medical services table
(1) The following provisions of the general medical services table shall have effect as if item 18375 were also specified in that provision:
(a) clause 1.2.1;
(b) subclause 1.2.4(1);
(c) subclause 1.2.5(1);
(d) subclauses 2.42A.1(1) and 2.42A.1(2).
Schedule 1 Specified Health Services
Fee for all States
Botulinum toxin type A (Botox), intravesical 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) spina bifida and who is at least 18 years of age; 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 with botulinum toxin type A; and
(c) the patient is willing and able to self-catheterise; and
(d) the requirements relating to botulinum toxin type A under the Pharmaceutical Benefits Scheme are complied with; and
(e) treatment is not provided on the same occasion as a service described 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