INSURANCE HEALTH (1992-1993 GENERAL MEDICAL SERVICES TABLE) REGULATIONS (AMENDMENT) 1993 NO. 145
HEALTH INSURANCE (1992-1993 GENERAL MEDICAL SERVICES TABLE) REGULATIONS (AMENDMENT) 1993 NO. 145
- TABLE OF PROVISIONS
1. Commencement
2. Amendment
3. Schedule (Table of general medical services)
1993 No. 145 HEALTH INSURANCE (1992-1993 GENERAL MEDICAL SERVICES TABLE)
REGULATIONS (AMENDMENT)
- REG 1
1. Commencement
1.1 These Regulations commence on 1 July 1993.
1993 No. 145 HEALTH INSURANCE (1992-1993 GENERAL MEDICAL SERVICES TABLE)
REGULATIONS (AMENDMENT)
- REG 2
2. Amendment
2.1 The Health Insurance (1992-1993 General Medical Services Table)
Regulations are amended as set out in these Regulations.
1993 No. 145 HEALTH INSURANCE (1992-1993 GENERAL MEDICAL SERVICES TABLE)
REGULATIONS (AMENDMENT)
- REG 3
3. Schedule (Table of general medical services)
3.1 Rules of Interpretation:
Subrule 1 (1):
Insert the following definition:
"'intensive care unit' means a separate hospital area that:
(a) is equipped and staffed so as to be 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) at least one specialist or consultant physician in the
speciality of Intensive Care who is immediately available during normal
working hours; and
(ii) a registered medical practitioner who is present in the
hospital and immediately available to the unit at all times; and
(iii) a Registered Nurse for at least 18 hours in each day; and
(c) has defined admission and discharge policies;".
3.2 Rules of Interpretation:
Subrule 1 (5):
Add at the end:
"; and
(d) if the referral:
(i) arises out of a dental service given 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
(ii) is given to a consultant physician;
a dental practitioner.".
3.3 Rules of Interpretation:
Subrule 11 (2):
After "13221,", insert: "13915, 13918, 13921, 13924, 13927, 13930, 13933,
13936, 13939, 13942, 13945, 13948,".
3.4 Item 11221:
Omit "67.00", substitute "53.00".
3.5 Item 11224:
Omit "40.00", substitute "32.00".
3.6 Item 11503: Omit the item, substitute:
"11503 Measurement of the mechanical or gas exchange function
of the respiratory system, or of respiratory muscle function,
or of ventilatory control mechanisms, using measurements of
various parameters including pressures, volumes, flow, gas
concentrations in inspired or expired air, alveolar gas or
blood, 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 1 or more such tests are performed
98.00".
3.7 Item 11600:
Omit the item, substitute:
"11600 Blood pressure monitoring by intravascular cannula (not
being a service associated with a service to which item
13818 or 13819 applies) (AU 4) 48.50".
3.8 After item 11700, insert:
"11701 Twelve-lead electrocardiography, report only where the
tracing has been forwarded to another medical practitioner,
including any consultation on the same day 12.20
11702 Twelve-lead electrocardiography, tracing only 12.20".
3.9 Item 11703:
Omit the item.
3.10 After item 11706, insert:
"11708 Continuous ECG recording of ambulatory patient for 12
or more hours, including microprocessor based analysis,
interpretation and report of recordings, not being a service
to which item 11709 applies 100.00".
3.11 Items 11709 and 11710:
Omit the items, substitute:
"11709 Continuous ECG recording (Holter) of ambulatory patient
for 12 or more hours involving recording and storage on a
device, utilising a system capable of superimposition and
full disclosure printout of at least 12 hours of recorded
ECG data, microprocessor based scanning analysis,
interpretation and report, including resting ECG and the
recording of parameters 132.00
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 prior to each activation and for 15
seconds after each activation, including transmission,
analysis, interpretation and report-payable once in any 4
week period 36.50
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 20.00".
3.12 Items 12000 and 12003:
Omit the items, substitute:
"12000 Skin sensitivity testing for allergens, using 1 to 20
allergens, not being a service associated with a service
to which item 12006 or 12009 applies 27.50
12003 Skin sensitivity testing for allergens, using more than 20
allergens, not being a service associated with a service
to which item 12006 or 12009 applies 41.50".
3.13 Item 13800 to 13806:
Omit the items, substitute:
"13809 Management of a patient in an Intensive Care Unit by a
specialist or consultant physician-including initial and
subsequent attendances, electrocardiograms, arterial
sampling, bladder catheterisation and blood
sampling-management on the first day 215.00
13812 Management of a patient in an Intensive Care Unit by a
specialist or consultant physician-including all attendances,
electrocardiograms, arterial sampling, bladder
catheterisation and blood sampling-management on each day
subsequent to the first day 160.00
13815 Central vein catheterisation (via jugular or subclavian vein)
by percutaneous or open exposure not being a service to
which item 13318 applies (AU 6) 60.00
13818 Right heart balloon flotation using a pulmonary artery
catheter, including pulmonary wedge pressure and cardiac
output measurement and including monitoring of pulmonary
arterial and central venous pressures on the day of
insertion-management on the first day 168.00
13819 Central venous pressure, pulmonary arterial pressure,
systemic arterial pressure or cardiac intracavity pressure,
continuous monitoring by indwelling catheter by a specialist
or consultant physician in an Intensive Care Unit-each day of
monitoring for each pressure up to a maximum of 4 pressures
(not being a service to which item 11600 or 13818 applies)
48.00
13821 Mechanical ventilation, initiation of, by a specialist or
consultant physician in conjunction with subsequent
management of ventilatory support on the first day in an
Intensive Care Unit 156.00
13824 Ventilatory support in an Intensive Care Unit, management
of, by a specialist or consultant physician-not being a
service to which item 13809 applies-each day 53.00
13827 Gastro-oesophageal balloon intubation, Minnesota,
Sengstaken-Blakemore or similar, for control of bleeding
from gastric oesophageal varices 130.00
13830 Intracranial pressure, monitoring of, by intraventricular or
subdural catheter, subarachnoid bolt or similar, by a
specialist or consultant physician-each day 53.00
13833 Continuous arterio-venous or veno-venous haemofiltration,
management by a specialist or consultant physician-on the
first day in an Intensive Care Unit 96.00
13836 Continuous arterio venous or veno venous haemofiltration,
management by a specialist or consultant physician-on each
day subsequent to the first day in an Intensive Care Unit
50.00".
3.14 Items 13900 to 13912:
Omit the items, substitute:
"13915 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 hours duration-payable once only
on the same day 46.00
13918 Chemotherapy, administration of, by intravenous infusion of
more than 1 hours duration but not more than 6 hours
duration-payable once only on the same day 69.00
13921 Chemotherapy, administration of, by intravenous infusion
of more than 6 hours duration-for the first day of treatment
78.00
13924 Chemotherapy, administration of, by intravenous infusion of
more than 6 hours duration-on each day subsequent to the
first in the same continuous treatment episode 46.00
13927 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 hours duration-payable once only on the
same day 60.00
13930 Chemotherapy, administration of, by intra-arterial infusion
of more than 1 hours duration but not more than 6 hours
duration-payable once only on the same day 83.00
13933 Chemotherapy, administration of, by intra-arterial infusion
of more than 6 hours duration-for the first day of treatment
92.00
13936 Chemotherapy, administration of, by intra-arterial infusion
of more than 6 hours duration-on each day subsequent to the
first in the same continuous treatment episode 60.00
13939 Implanted pump or reservoir, loading of, with a therapeutic
agent or agents, not being a service associated with a
service to which item 13915, 13918, 13921, 13924, 13927,
13930, 13933 or 13936 applies 69.00
13942 Ambulatory drug delivery device, loading of, with a
therapeutic agent or agents for the infusion of the agent or
agents via the intravenous, intra-arterial or spinal routes,
not being a service associated with a service to which item
13915, 13918, 13921, 13924, 13927, 13930, 13933 or 13936
applies 46.00
13945 Long-term implanted drug delivery device, accessing of
37.00
13948 Cytotoxic agent, instillation of, into a body cavity 46.00".
3.15 Item 14203:
Omit the item, substitute:
"14203 Hormone or living tissue implantation, by direct
implantation involving incision and suture 36.00".
3.16 After item 14206, insert:
"14209 Intra-arterial infusion or retrograde intravenous
perfusion of a sympatholytic agent 63.00".
3.17 Item 18212:
Omit the item, substitute:
"18212 Maintenance of narcotic analgesia referred to in item
18206 by the administration of a narcotic or maintenance
of local anaesthetic referred to in item 18209 through
an in situ needle or catheter, when performed other
than by the operating surgeon 28.50".
3.18 Item 30213:
Omit the item, substitute:
"30213 Telangiectases or starburst vessels on the head or
neck, diathermy or sclerosant injection of, including
associated consultation-for a session of at least 20
minutes duration 77.00".
3.19 Item 30309:
Omit "(AU 10)", substitute "(AU 14)".
3.20 Item 30479:
Omit the item, substitute:
"30479 Endoscopic laser therapy for neoplasia and benign
vascular lesions or strictures of the gastrointestinal
tract (AU 12) 335.00".
3.21 Item 30514:
Omit the item substitute:
"30514 Morbid obesity, surgical reversal of procedure to which
item 30511 or 30512 applies (AU 22) 1,085.00".
3.22 Items 30535 to 30539:
Omit the items, substitute:
"30535 Oesophagectomy with gastric reconstruction by abdominal
mobilisation and thoracotomy (AU 27) 1,195.00
30536 Oesophagectomy involving gastric reconstruction by
abdominal mobilisation, thoracotomy and anastomosis
in the neck-1 surgeon (AU 31) 1,210.00
30538 Oesophagectomy involving gastric reconstruction by
abdominal mobilisation, thoracotomy and anastomosis in
the neck-conjoint surgery, principal surgeon (including
aftercare) (AU 31) 840.00
30539 Oesophagectomy involving gastric reconstruction by
abdominal mobilisation, thoracotomy and anastomosis
in the neck-conjoint surgery, co-surgeon 615.00".
3.23 Item 32760:
Omit the item, substitute:
"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 (AU 9)
285.00".
3.24 Item 35625:
Omit the item, substitute:
"35625 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, not being a service associated
with a service to which item 30390 applies (AU 9)
425.00."
3.25 Item 38221:
Omit the item, substitute:
"38250 Single chamber permanent transvenous electrode,
insertion of (AU 12) 450.00
38253 Permanent pacemaker, insertion or replacement of (AU 12)
180.00
38256 Temporary transvenous pacemaking electrode, insertion of
(AU 11) 188.00
38259 Permanent dual chamber transvenous electrodes,
insertion of (AU 12) 590.00".
3.26 After item 38409, insert: "38410 Intercostal drain, insertion of,
with pleurodesis and not
involving resection of rib (excluding aftercare) (AU 7)
116.00".
3.27 Items 38432 and 38434:
Omit the items.
3.28 After item 38446, insert:
"38447 Pericardiectomy via sternotomy or anterolateral
thoracotomy without cardiopulmonary bypass (AU 28)
1,080.00".
3.29 After item 38448, insert: "38449 Pericardiectomy via sternotomy or
anterolateral
thoracotomy with cardiopulmonary bypass (AU 32) 1,510.00".
3.30 Item 38454:
Omit the item, substitute:
"38455 Tracheal excision and repair, with cardiopulmonary
bypass (AU 40) 1,640.00".
38456 Intrathoracic operation on heart, lungs, great vessels,
bronchial tree, oesophagus or mediastinum, or on more
than 1 of those organs, not being a service to which
another item in this Group applies (AU 28) 1,080.00
38457 Pectus excavatum or pectus carinatum, repair or radical
correction of (AU 16) 1,010.00
38458 Pectus excavatum, repair of, with implantation of
subcutaneous prosthesis (AU 16) 535.00
38460 Sternal wire or wires, removal of (AU 8) 194.00
38462 Sternotomy wound, debridement of, not involving reopening of
the mediastinum (AU 12) 230.00
38464 Sternotomy wound, d bridement of, involving curettage of
infected bone with or without removal of wires but not
involving reopening of the mediastinum (AU 12) 250.00
38466 Sternum, reoperation on for dehiscence or infection
involving reopening of the mediastinum, with or without
(AU rewiring 18) 675.00
38468 Sternum and mediastinum, reoperation for infection of,
involving muscle advancement flaps or greater omentum
(AU 28) 1,040.00
38469 Sternum and mediastinum, reoperation for infection of,
involving muscle advancement flaps and greater omentum
(AU 32) 1,210.00".
3.31 Item 38476 to 38488:
Omit the items, substitute:
"38486 Aortic valve, decalcification of (AU 32) 1,210.00
38487 Mitral valve, open valvotomy of (AU 32) 1,210.00
38488 Valve replacement with bioprosthesis, mechanical
prosthesis or unstented xenograft (AU 32) 1,345.00".
3.32 Item 38491:
Omit the item, substitute:
"38492 Valve replacement with allograft, subcoronary or
cylindrical implant (AU 36) 1,600.00".
3.33 After item 38571, insert:
"38572 Operative management of acute rupture or dissection,
in conjunction with procedures on the thoracic aorta
(AU 25) 1,400.00".
3.34 Items 38600 and 38603:
Omit the items, substitute:
"38600 Central cannulation for cardiopulmonary bypass
excluding post-operative management, not being a service
associated with a service to which another item in this
Subgroup applies (AU 16) 1,080.00
38603 Peripheral cannulation for cardiopulmonary bypass
excluding post-operative management (AU 13) 675.00".
3.35 Items 38609 and 38612:
Omit the items, substitute:
"38609 Intra-aortic balloon pump, insertion of, by
arteriotomy (AU 14) 340.00
38612 Intra-aortic balloon pump, removal of, with closure
of artery by direct suture (AU 14) 380.00
38613 Intra-aortic balloon pump, removal of, with closure
of artery by patch graft (AU 20) 475.00".
3.36 After item 39012, insert:
"39013 Injection under image intensification with 1 or more
of contrast media, local anaesthetic or corticosteroid
into 1 or more zygo-apophyseal or costo-transverse
joints or 1 or more primary posterior rami of spinal
nerves 77.00".
3.37 Item 39015:
Omit the item, substitute:
"39015 Ventricular reservoir, external ventricular drain or
intracranial pressure monitoring device, insertion
of-including burr-hole (excluding after-care) (AU 12)
265.00".
3.38 Item 39115:
Omit the item, substitute:
"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) (AU 6) 70.00".
3.39 After item 39124, insert:
"39125 Spinal catheter, insertion of-for an automated
infusion device (AU 8) 210.00
39126 Automated subcutaneous infusion device, insertion
of (AU 8) 255.00".
3.40 After item 39127, insert:
"39128 Automated subcutaneous infusion device and spinal catheter,
insertion of (AU 11) 465.00".
3.42 Item 39130:
Omit the item, substitute:
39130 Percutaneous epidural electrode, insertion of 1 or
more of-for spinal stimulation (AU 10) 430.00
39131 Percutaneous epidural electrodes, management, adjustment,
electronic programming and trial of stimulation of, by a
medical practitioner-each day 90.00
3.42 After item 39133, insert:
39134 Spinal neurostimulator receiver or pulse generator,
subcutaneous placement of (AU 8) 240.00
3.43 Items 39136 and 39139:
Omit the items, substitute:
"39136 Percutaneous epidural implant for management of pain,
removal of (AU 7) 112.00
39139 Epidural electrode for management of pain, insertion
of 1 or more of by laminectomy, including implantation
of pulse generator (1 or 2 stages) (AU 18) 760.00".
3.44 After item 39321, insert:
"39323 Percutaneous neurotomy by cryoneurotomy or radiofrequency
lesion generator, not being a service to which another
item applies (AU 8) 194.00".
3.45 Items 39324 and 39327:
Omit the items, substitute:
"39324 Neurectomy, neurotomy or removal of tumour from
superficial peripheral nerve, by open operation (AU 8)
194.00
39327 Neurectomy, neurotomy or removal of tumour from deep
peripheral nerve, by open operation (AU 10) 335.00".
3.46 After item 39330, insert:
"39331 Carpal tunnel release (division of transverse carpal
ligament), by any method (AU 7) 194.00".
3.47 Item 39612:
Omit the item, substitute:
"39612 Fractured skull, compound, depressed or complicated,
with dural penetration and brain laceration, operation
for (AU 14) 790.00".
3.48 Item 39703:
Omit the item, substitute:
"39703 Intracranial tumour, cyst or other brain tissue,
burr-hole and biopsy of, or drainage of, or both (AU 10)
365.00".
3.49 Item 39715: Omit the item, substitute:
"39715 Pituitary tumour, removal of, by transcranial or
transphenoidal approach (AU 25) 1,400.00".
3.50 Item 40015:
Omit "168.00", substitute "450.00".
3.51 Items 40300 to 40306:
Omit the items, substitute:
"40300 Intervertebral disc or discs, laminectomy for removal
of (AU 12) 675.00
40301 Intervertebral disc or discs, microsurgical
dissectomy of (AU 12) 675.00
40303 Recurrent disc lesion or spinal stenosis, or both,
laminectomy for-1 level (AU 13) 770.00
40306 Spinal stenosis, laminectomy for, involving more
than 1 vertebral interspace (disc level) (AU 16)
1,010.00".
3.52 Item 40800:
Omit the item, substitute:
"40800 Stereotactic anatomical localisation, as an
independent procedure (AU 17) 450.00
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 (AU 25)
1,230.00".
3.53 Item 40900:
Omit the item.
3.54 Insert after item 41907:
"41910 Duct of major salivary gland, transposition of (AU 16)
275.00".
3.55 Item 45033:
Omit the item, substitute:
"45033 Angioma, large or involving deeper tissue including
facial muscle or breast, excision and suture of (AU 9)
170.00".
3.56 Item 45045:
Omit the item, substitute:
"45045 Arteriovenous malformation on eyelid, nose, lip,
ear, neck, hand, thumb, finger or genitals,
excision of (AU 16) 215.00".
3.57 Item 45051:
Omit the item, substitute:
"45051 Contour reconstruction for pathological deformity,
insertion of foreign implant (non biological but
excluding injection of liquid or semisolid material)
by open operation (AU 10) 335.00".
3.58 Item 45206:
Omit the item, substitute:
"45206 Single stage local flap where indicated to repair
1 defect, on eyelid, nose, lip, ear, neck, hand,
thumb, finger or genitals (AU 12) 270.00".
3.59 After item 45500, insert:
"45502 Microvascular anastomosis of artery or vein using
microsurgical techniques, for reimplantation of
limb or digit or free transfer of tissue (AU 38)
1,250.00".
3.60 Items 45506 to 45518:
Omit the items, substitute:
"45506 Scar, of face or neck, not more than 3 cm in length,
revision of, where undertaken in the operating
theatre of a hospital or approved day-hospital
facility, or where performed by a specialist in
the practice of his or her specialty (AU 8) 154.00
45512 Scar, of face or neck, more than 3 cm in length,
revision of, where undertaken in the operating
theatre of a hospital or approved day-hospital facility,
or where performed by a specialist in the practice
of his or her specialty (AU 9) 210.00
45515 Scar, other than on face or neck, not more than
7 cm in length, revision of, as an independent
procedure, where undertaken in the operating theatre
of a hospital or approved day-hospital facility,
or where performed by a specialist in the practice
of his or her specialty (AU 10) 132.00
45518 Scar, other than on face or neck, more than 7 cm
in length, revision of, as an independent procedure,
where undertaken in the operating theatre of a hospital
or approved day-hospital facility, or where performed
by a specialist in the practice of his or her
speciality (AU 12) 158.00".
3.61 Items 45551 and 45554:
Omit the items, substitute:
"45551 Breast prosthesis, removal of, with complete
excision of fibrous capsule as an independent
procedure (AU 10) 315.00
45552 Breast prosthesis, removal of, with complete
excision of fibrous capsule and replacement of
prosthesis (AU 13) 450.00
45554 Breas...