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A medical service to which an item in this Schedule (other than this item) applies, if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who 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) any other item in this Schedule applying to the service;

other than a service associated with a service:

(e) to which another item in this Group applies; or

(f) that is a general practice support service; or

(g) that is a MyMedicare service

Fee: $8.80 Benefit: 85% = $7.50

(See para MN.1.1, MN.1.3 of explanatory notes to this Category)

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A medical service to which an item in this Schedule (other than this item) applies, if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who 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) any other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 2 area;

other than a service associated with a service:

(f) to which another item in this Group applies; or

(g) that is a general practice support service; or

(h) that is a MyMedicare service

Fee: $13.35 Benefit: 85% = $11.35

(See para MN.1.1, MN.1.4 of explanatory notes to this Category)

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A medical service to which:

(a) item 585, 588, 591, 594, 599, 600, 5003, 5010, 5220 or 5260 applies; or

(b) item 761 or 772 applies (see the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018);

if:

(c) the service is an unreferred service; and

(d) the service is provided to a person who is not an admitted patient of a hospital; and

(f) the service is not provided in consulting rooms; and

(g) the service is provided in any of the following areas:

(i) a Modified Monash 2 area;

(ii) a Modified Monash 3 area;

(iii) a Modified Monash 4 area;

(iv) a Modified Monash 5 area;

(v) a Modified Monash 6 area;

(vi) a Modified Monash 7 area; and

(h) the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an area mentioned in paragraph (g); and

(i) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item mentioned in paragraph (a) or (b) applying to the service

Fee: $13.35 Benefit: 85% = $11.35

(See para MN.1.1, MN.1.3, MN.1.4 of explanatory notes to this Category)

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Anaesthesia (whether general anaesthesia or not) of a patient that:
(a) is managed by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital; and
(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and
(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

Fee: $177.55 Benefit: 75% = $133.20 85% = $150.95

(See para TN.1.24 of explanatory notes to this Category)

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Anaesthesia (whether general anaesthesia or not) of a patient that:
(a) is managed by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital; and
(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and
(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

Fee: $133.30 Benefit: 75% = $100.00 85% = $113.35

(See para TN.1.24 of explanatory notes to this Category)

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Examination of glottal cycles and vibratory characteristics of the vocal folds by a specialist in the practice of the specialist’s specialty of otolaryngology using videostroboscopy, including capturing audio, video, frequency and intensity, for confirmation of diagnosis , or for confirmation of treatment effectiveness where there is failure to progress or respond as expected, for:

1. dysphonia where non stroboscopic techniques of the visualising the larynx have failed to identify any frank abnormality of the vocal folds; or
2. benign or malignant vocal fold lesions; or
3. premalignant or malignant laryngeal lesions; or
4. vocal fold motion impairment or glottal insufficiency; or
5. evaluation of vocal fold function after treatment or phonosurgery

other than a service associated with a service to which item 41764 applies or with a services associated with the administration of a general anaesthetic

Multiple Operation Rule

Fee: $222.10 Benefit: 75% = $166.60 85% = $188.80

(See para TN.8.76 of explanatory notes to this Category)

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(Note. Where an anaesthetic combines a regional nerve block with a general anaesthetic for an operative procedure, benefits will be paid only under the anaesthetic item relevant to the operation. The items in this Group are to be used in the practice of oral and maxillofacial surgery and are not to be used for dental procedures (eg. restorative dentistry or dental extraction.))

TRIGEMINAL NERVE, primary division of, injection of an anaesthetic agent

Fee: $149.45 Benefit: 75% = $112.10 85% = $127.05

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Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and
(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and
(c) if a specialist in diagnostic radiology, nuclear medicine, sexual health medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and
(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Bulk bill incentive

Fee: $199.70 Benefit: 75% = $149.80 85% = $169.75

(See para IN.0.19 of explanatory notes to this Category)

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Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
     (a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and
     (b) if indicated, assess the progress and management of:
          (i) priapism; or
          (ii) fibrosis of any type; or
          (iii) fracture of the tunica; or
          (iv) arteriovenous malformations; and
     (c) if a specialist in diagnostic radiology, nuclear medicine, sexual health medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and
     (d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Bulk bill incentive

Fee: $199.70 Benefit: 75% = $149.80 85% = $169.75

(See para IN.0.19 of explanatory notes to this Category)

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Quantitation of glycated haemoglobin (HbA1c) performed in the management of established diabetes, if performed:

(a) as a point‑of‑care test; and

(b) by or on behalf of a medical practitioner who works in a general practice that is accredited to the Royal Australian College of General Practitioners Standards for point‑of-care testing under the National General Practice Accreditation Scheme; and

(c) using a method certified by the National Glycohemoglobin Standardization Program (NGSP), if the instrumentation used has a total coefficient variation less than 3.0% at 48 mmol/mol (6.5%)

Applicable not more than 3 times per 12 months per patient

Fee: $11.80 Benefit: 75% = $8.85 85% = $10.05

(See para PR.9.4 of explanatory notes to this Category)

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