an Australian citizen; or

(b) a person who is, within the meaning of the Migration Act 1958, the holder of a permanent visa; or

(ba) a person who has been granted, or who is included in, a return endorsement or a resident return visa in force under the Migration Act 1958; or

a New Zealand citizen who is lawfully present in Australia; or

a person (not being a person referred to in paragraph (a), (b), (ba) or (c)) who is lawfully present in Australia and whose continued presence in Australia is not subject to any limitation as to time imposed by law; or

a person who:

(i) is, within the meaning of the Migration Act 1958, the holder of a temporary visa; and

is not covered by regulations made under subsection 6A(1); and

has applied for a permanent visa under that Act and the application has not been withdrawn or otherwise finally determined; and

has not, both:

(A) on or after the commencement of this paragraph, made an application for a protection visa under that Act (whether or not the person has applied for any other visa), other than an application that has been withdrawn or otherwise finally determined; and

(B) whether before or after the commencement of this paragraph, made an application for a parent visa under that Act (whether or not the person has applied for any other visa and whether or not the application for the parent visa has been withdrawn or otherwise finally determined); and

has not, whether before or after the commencement of this paragraph, made an application for a parent visa under that Act (whether or not the person has applied for any other visa), other than an application that has been withdrawn or otherwise finally determined; and

in respect of whom either:

(A) another person, being the person’s spouse, parent or child (each having the same meaning as in the Migration Act 1958), is an Australian citizen or the holder of a permanent visa under that Act; or

(B) an authority to work in Australia is in force.

Australian university has the same meaning as in the Higher Education Support Act 2003.

authorised representative has the same meaning as in the My Health Records Act 2012.

bank includes, but is not limited to, a body corporate that is an ADI (authorised deposit-taking institution) for the purposes of the Banking Act 1959.

base for mobile diagnostic imaging equipment has the meaning given by section 23DZL.

base for mobile radiation oncology equipment has the meaning given by section 23DZZK.

Bonded Medical Program: see section 124ZD.

Bonded Medical Program rules: see section 124ZT.

bonded participant: see section 124ZE.

census date has the same meaning as in the Higher Education Funding Act 1988.

Chief Executive Centrelink has the same meaning as in the Human Services (Centrelink) Act 1997.

Chief Executive Medicare has the same meaning as in the Human Services (Medicare) Act 1973.

chiropractor means a person who is registered under the National Law in the chiropractic profession.

civil penalty order means an order under subsection 125A(2).

civil penalty provision has the meaning given by section 125B.

clinically relevant service means a service rendered by a medical or dental practitioner or an optometrist that is generally accepted in the medical, dental or optometrical profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.

complying health insurance policy has the meaning given by section 63-10 of the Private Health Insurance Act 2007.

consultant physician means a medical practitioner in relation to whom there is in force a determination under section 3DB or 3E that the medical practitioner is recognised for the purposes of this Act as a consultant physician in that specialty.

course of study in medicine has the same meaning as in the Higher Education Support Act 2003.

dental benefit has the same meaning as in the Dental Benefits Act 2008.

dental practitioner means a person who is registered under the National Law in the dental profession.

diagnostic imaging accreditation scheme means a scheme established by the Minister under section 23DZZIAA.

diagnostic imaging equipment means equipment that is primarily used in the carrying out of a diagnostic imaging procedure.

diagnostic imaging premises has the meaning given by section 23DZM.

diagnostic imaging procedure means a procedure for the production of images (for example, X-rays, computerised tomography scans, ultrasound scans, magnetic resonance imaging scans and nuclear scans) for use in the rendering of diagnostic imaging services.

Diagnostic Imaging Register means the Register kept under section 23DZK.

diagnostic imaging service means:

an R-type diagnostic imaging service; or

an NR-type diagnostic imaging service;

to which an item of the diagnostic imaging services table relates.

diagnostic imaging services table means the table prescribed under section 4AA.

disclose includes divulge or communicate.

eligible location means:

an area prescribed by the Bonded Medical Program rules as a regional, rural or remote area; or

an area prescribed by the Bonded Medical Program rules as an area of workforce shortage.

eligible midwife has the meaning given by section 21.

eligible nurse practitioner means a person who: is a nurse practitioner; and meets the requirements (if any) specified in the regulations for the purposes of this paragraph.

is a nurse practitioner; and

meets the requirements (if any) specified in the regulations for the purposes of this paragraph.

eligible overseas representative means a person who is: the head of a diplomatic mission of another country, or the head of a consular post of another country, established in Australia; or a member of the staff of such a diplomatic mission, or a member of the staff of such a consular post; or a member of the family of a person referred to in paragraph (a) or (b), being a member who forms part of the household of that person; being a person who is neither an Australian citizen nor a person domiciled in Australia but who, under an agreement between the Government of the Commonwealth and the Government of that other country, is to be treated, for the purpose of the provision of medical, hospital and other care, as if the person were an Australian resident.

the head of a diplomatic mission of another country, or the head of a consular post of another country, established in Australia; or

a member of the staff of such a diplomatic mission, or a member of the staff of such a consular post; or

a member of the family of a person referred to in paragraph (a) or (b), being a member who forms part of the household of that person;

being a person who is neither an Australian citizen nor a person domiciled in Australia but who, under an agreement between the Government of the Commonwealth and the Government of that other country, is to be treated, for the purpose of the provision of medical, hospital and other care, as if the person were an Australian resident.

eligible person means an Australian resident or an eligible overseas representative.

entrusted public official means any of the following: the Minister; the Chief Executive Medicare; the Secretary of a relevant Department; an APS employee in a relevant Department; (e) a Departmental employee within the meaning of the Human Services (Medicare) Act 1973; any other person employed or engaged by the Commonwealth to provide services to the Commonwealth in connection with a relevant Department or Services Australia; any other person employed or engaged (however described) by a person described in paragraph (f) to provide services in connection with the services mentioned in that paragraph.

the Minister;

the Chief Executive Medicare;

the Secretary of a relevant Department;

an APS employee in a relevant Department;

(e) a Departmental employee within the meaning of the Human Services (Medicare) Act 1973;

any other person employed or engaged by the Commonwealth to provide services to the Commonwealth in connection with a relevant Department or Services Australia;

any other person employed or engaged (however described) by a person described in paragraph (f) to provide services in connection with the services mentioned in that paragraph.

excessive pathology service means a pathology service: in respect of which medicare benefit has become or may become payable; and that is not reasonably necessary for the adequate medical or dental care of the patient concerned.

in respect of which medicare benefit has become or may become payable; and

that is not reasonably necessary for the adequate medical or dental care of the patient concerned.

extended compliance determination has the meaning given by subsection 124ZUA(1).

finally determined has the same meaning as in the Migration Act 1958.

friendly society means:

(a) a body that is a friendly society for the purposes of the Life Insurance Act 1995; or

a body that is registered or incorporated as a friendly society under a law of a State or Territory; or

(c) a body that is permitted, by a law of a State or Territory, to assume or use the expression friendly society; or

(d) a body that, immediately before the date that is the transfer date for the purposes of the Financial Sector Reform (Amendments and Transitional Provisions) Act (No. 1) 1999, was registered or incorporated as a friendly society under a law of a State or Territory.

general medical services table, means the table prescribed under section 4.

general practitioner means:

a medical practitioner who is registered under the National Law in the specialty of general practice; or

a medical practitioner of a kind prescribed by the regulations for the purposes of this paragraph.

guidance and appeals panel has the same meaning as in the Administrative Review Tribunal Act 2024.

guidance and appeals panel application has the same meaning as in the Administrative Review Tribunal Act 2024.

hospital has the meaning given by subsection 121-5(5) of the Private Health Insurance Act 2007.

hospital service means a health service of a kind provided in a hospital and includes: accommodation in a hospital for the purposes of receiving treatment; and nursing care and treatment; and medical care and treatment including diagnostic services; and outpatient, accident and emergency services.

accommodation in a hospital for the purposes of receiving treatment; and

nursing care and treatment; and

medical care and treatment including diagnostic services; and

outpatient, accident and emergency services.

hospital-substitute treatment has the same meaning as in the Private Health Insurance Act 2007.

hospital treatment has the meaning given by section 121-5 of the Private Health Insurance Act 2007.

Human Services Minister means the Minister administering the Human Services (Centrelink) Act 1997.

Immigration Department means the Department administered by the Minister administering the Migration Act 1958.

initiate means make the decision by reason of which the service is rendered.

item means an item in the table.

listed:

in relation to diagnostic imaging equipment—has the meaning given by subsections 16D(4) and (5); and

in relation to radiation oncology equipment—has the meaning given by subsections 16F(6) and (7).

medical entrepreneur has the meaning given by section 3B.

medical expenses means an amount payable in respect of a professional service.

medical practitioner means a person who is registered under the National Law in the medical profession.

medicare benefit means a medicare benefit under Part II.

medicare number has the same meaning as in subsection 84(1) of the National Health Act 1953.

medicare program has the same meaning as in the Human Services (Medicare) Act 1973.

midwife means a person who is registered under the National Law in the midwifery profession.

Migration Regulations means regulations made under the Migration Act 1958.

month means a month of the year.

My Health Record system has the same meaning as in the My Health Records Act 2012.

My Health Record System Operator means the System Operator within the meaning of the My Health Records Act 2012.

National Law means:

(a) for a State or Territory (other than Western Australia)—the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it applies (with or without modification) as a law of the State or Territory; or

(b) for Western Australia—the Health Practitioner Regulation National Law (WA) Act 2010 (WA), so far as that Act corresponds to the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).

nominated representative has the same meaning as in the My Health Records Act 2012.

NR-type diagnostic imaging service means a diagnostic imaging service corresponding to an item of the diagnostic imaging services table that is classified as an NR-type service in the table.

nurse practitioner means a person who is registered under the National Law in the nursing profession as a nurse practitioner.

nursing care means nursing care given by or under the supervision of a registered nurse.

nursing-home type patient means a patient in the hospital who has been provided with accommodation and nursing care, as an end in itself, for a continuous period exceeding 35 days.

optometrist means a person who is registered under the National Law in the optometry profession.

ordinarily located:

in relation to diagnostic imaging premises—has a meaning affected by subsection 16D(6); and

in relation to bases for mobile diagnostic imaging equipment—has a meaning affected by subsection 16D(8); and

in relation to radiation oncology premises—has a meaning affected by subsection 16F(8); and

in relation to bases for mobile radiation oncology equipment—has a meaning affected by subsection 16F(10).

organization means a society, body or group of persons, whether corporate or unincorporate.

osteopath means a person who is registered under the National Law in the osteopathy profession.

out-patient service means a health service or procedure provided by the hospital to an eligible person other than a patient of the hospital.

paid work means work for financial gain or reward (whether as an employee, a self-employed person or otherwise).

parent visa: a person has applied for a parent visa if:

the person has applied for a permanent visa included in a class of visas under the Migration Regulations, being a class that has the word “parent” in its title; or

before 1 November 1999 the person applied for a Change in Circumstance (Residence) (Class AG) visa, a Family (Residence) (Class AO) visa or a General (Residence) (Class AS) visa under the Migration Regulations and:

the person was nominated for the grant of that visa by a child of the person, being a child who was at least 18 years old when the application was made; or

the person was included in an application made by a person covered by subparagraph (i).

participating midwife means:

if the Minister has approved a common form of undertaking under section 21A—an eligible midwife in respect of whom there is in force an undertaking given by him or her and accepted by the Minister under section 21B; or

otherwise—an eligible midwife.

participating nurse practitioner means:

if the Minister has approved a common form of undertaking under section 22—an eligible nurse practitioner in respect of whom there is in force an undertaking given by him or her and accepted by the Minister under section 22A; or

otherwise—an eligible nurse practitioner.

pathologist-determinable service means a pathology service specified, or a pathology service included in a class of pathology services specified, in a determination in force under section 4BA.

pathology service means a medical service to which an item of the pathology services table relates.

pathology services table, means the table prescribed under section 4A.

patient, in relation to a hospital, does not include:

a member of the staff of the hospital who is receiving treatment in his or her own quarters; or

except as provided by subsection (2), a newly-born child whose mother also occupies a bed in the hospital.

patient contribution means:

in relation to a nursing-home type patient of a recognized hospital in a State such amount as is determined by the Minister from time to time for the purposes of this paragraph with respect to that State;

in relation to a nursing-home type patient of a recognized hospital in an internal Territory, such amount as is determined by the Minister from time to time for the purposes of this paragraph in relation to that Territory; or

in relation to a nursing-home type patient of a private hospital in a State or internal Territory, such amount as is determined by the Minister from time to time for the purposes of this paragraph with respect to that State or Territory.

pecuniary penalty order means an order made under section 125A.

permanent visa has the same meaning as in the Migration Act 1958.

physiotherapist means a person who is registered under the National Law in the physiotherapy profession.

podiatrist means a person who is registered under the National Law in the podiatry profession.

practitioner means a medical practitioner or a dental practitioner.

prescribed pathology service means a pathology service specified, or a pathology service included in a class of pathology services specified, in a determination in force under section 4BB.

primary information:

for the purposes of Division 4 of Part IIB—has the meaning given by section 23DZR; and

for the purposes of Part IIC—has the meaning given by section 23DZZQ.

private health insurer has the same meaning as in the Private Health Insurance Act 2007.

private hospital means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.

private patient means a patient of the hospital who is not a public patient.

professional attention means:

medical or surgical treatment by or under the supervision of a medical practitioner; or

obstetric treatment by or under the supervision of a medical practitioner or a registered nurse with obstetric qualifications; or

dental treatment by or under the supervision of a dental practitioner; or

podiatric treatment by an accredited podiatrist.

professional service means:

a service (other than a diagnostic imaging service) to which an item relates, being a clinically relevant service that is rendered by or on behalf of a medical practitioner; or

a prescribed medical service to which an item relates, being a clinically relevant service that is rendered by a dental practitioner approved by the Minister in writing for the purposes of this definition; or

a service to which an item relates, being a clinically relevant service that is rendered by an optometrist; or

a pathology service that is rendered by or on behalf of an approved pathology practitioner pursuant to a request made in accordance with subsection 16A(4) by:

a treating practitioner; or

another approved pathology practitioner who received a request for the service made by the treating practitioner; or

a pathology service (other than a service referred to in paragraph (d)) that is a clinically relevant service rendered by or on behalf of an approved pathology practitioner other than a medical practitioner; or

a diagnostic imaging service that is rendered by or on behalf of a medical practitioner pursuant to a subsection 16B(1) request; or

a diagnostic imaging service (other than a service referred to in paragraph (f)) that is a clinically relevant service rendered by or on behalf of a medical practitioner.

proprietor:

in relation to a pathology laboratory—means the person or authority having effective control of:

the laboratory premises, whether or not the holder of an estate or interest in the premises; and

the use of equipment used in the laboratory; and

the employment of staff in the laboratory; and

in relation to diagnostic imaging premises or a base for mobile diagnostic imaging equipment—has the meaning given by section 23DZO; and

in relation to radiation oncology premises or a base for mobile radiation oncology equipment—has the meaning given by section 23DZZN; and

in relation to other premises—means the person, authority or body of persons having effective control of the premises, whether or not he or she or it is the holder of an estate or interest in the premises.

protection visa means a permanent or temporary visa included in a class of visas under the Migration Regulations, being a class that has the word “protection” in its title.

public hospital service means a hospital service provided in: a recognised hospital; or a hospital in respect of which the Commonwealth, or a State, provides funding for the provision of hospital services to public patients.

a recognised hospital; or

a hospital in respect of which the Commonwealth, or a State, provides funding for the provision of hospital services to public patients.

public patient means a patient in respect of whom the hospital provides comprehensive care, including all necessary medical, nursing and diagnostic services and, if they are available at the hospital, dental and paramedical services, by means of its own staff or by other agreed arrangements.

radiation oncology equipment means equipment that is primarily used in rendering a radiation oncology service.

radiation oncology premises has the meaning given by section 23DZZL.

Radiation Oncology Register means the Register kept under section 23DZZJ.

radiation oncology service has the meaning given by subsection 16F(2).

recognised hospital means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Private Health Insurance Act 2007 that the hospital is a public hospital.

registered:

in relation to diagnostic imaging premises—has the meaning given by subsection 16D(2); and

in relation to a base for mobile diagnostic imaging equipment—has the meaning given by subsection 16D(3); and

in relation to radiation oncology premises—has the meaning given by subsection 16F(4); and

in relation to a base for mobile radiation oncology equipment—has the meaning given by subsection 16F(5).

registered nurse means a person who is registered under the National Law in the nursing profession as a registered nurse.

relevant dental benefits offence means:

(a) an offence against Dental Benefits Act 2008; orsection 50, 51, 52, 53 or 54 of the

an offence against:

(i) Crimes Act 1914; orsection 6 of the

(ii) Criminal Code;section 11.1, 11.4 or 11.5 of the

that relates to an offence referred to in paragraph (a) of this definition; or

(c) an offence against Criminal Code that relates to a claim for payment in respect of the rendering of a dental service (within the meaning of the Dental Benefits Act 2008).section 134.1, 134.2, 135.1, 135.2, 135.4, 136.1, 137.1, 144.1, 145.1, 145.4 or 145.5 of the

relevant Department means any of the following: the Department administered by the Minister who administers this Act; (b) the Department administered by the Minister who administers the Dental Benefits Act 2008; (c) the Department administered by the Minister who administers the Human Services (Centrelink) Act 1997; (d) the Department administered by the Minister who administers the Human Services (Medicare) Act 1973; (e) the Department administered by the Minister who administers the National Health Act 1953. resolved, in relation to an application under section 19AE: see subsections 19AE(10) and (11). return of service obligation: see section 124ZF.

the Department administered by the Minister who administers this Act;

(b) the Department administered by the Minister who administers the Dental Benefits Act 2008;

(c) the Department administered by the Minister who administers the Human Services (Centrelink) Act 1997;

(d) the Department administered by the Minister who administers the Human Services (Medicare) Act 1973;

(e) the Department administered by the Minister who administers the National Health Act 1953.

resolved, in relation to an application under section 19AE: see subsections 19AE(10) and (11).

return of service obligation: see section 124ZF.

RoSO compliance period means the period referred to in paragraph 124ZF(2)(a).

R-type diagnostic imaging service means a diagnostic imaging service corresponding to an item of the diagnostic imaging services table that is classified as an R-type service in the table.

Rural Health Minister means the Minister responsible for health in rural, regional or remote areas.

Secretary means the Secretary of the Department.

shares with the My Health Record system has the same meaning as in the My Health Records Act 2012.

specialist means a medical practitioner in relation to whom there is in force a determination under section 3DB or 3E that the medical practitioner is recognised for the purposes of this Act as a specialist in that specialty, or a medical practitioner who is taken to be so recognised under section 3D.

subsection 16B(1) request means a request of a kind referred to in subsection 16B(1).

table means the table consisting of: the general medical services table; and the pathology services table; and the diagnostic imaging services table. upload exception applies: see subsection 19AD(3). upload rules: see section 19AI.

the general medical services table; and

the pathology services table; and

the diagnostic imaging services table.

upload exception applies: see subsection 19AD(3).

upload rules: see section 19AI.

use includes make a record of.

Veterans’ Affairs Department means the Department administered by the Veterans’ Affairs Minister.

Veterans’ Affairs Minister means the Minister administering the Veterans’ Entitlements Act 1986.

a newly-born child who occupies an approved bed in an intensive care facility in a hospital, being a facility approved by the Minister for the purposes of this subsection, for the purpose of the provision of special care shall be deemed to be a patient of the hospital; and

where there are two or more newly born children of the same mother in a hospital and those children are not in-patients of the hospital by virtue of paragraph (a)—each such child in excess of 1 shall be deemed to be a patient of the hospital.

pre-medication of the patient in preparation for the administration of the anaesthetic; and

pre-operative examination of the patient in preparation for the administration of the anaesthetic, being an examination carried out during the attendance at which the anaesthetic is administered;

shall, for the purposes of this Act, be deemed to form part of the professional service constituted by the administration of the anaesthetic.

it is rendered by another person who is not a medical practitioner, and who provides the service, in accordance with accepted medical practice, under the supervision of the medical practitioner; and

it is not a service of a kind specified in regulations made for the purposes of this paragraph.

a professional service prescribed by the regulations for the purposes of this paragraph is rendered by a medical practitioner who is a specialist trainee (see subsection (20)); and

the specialist trainee renders the service under the supervision of another medical practitioner who is present at all times while the specialist trainee renders the service;

then, for the purposes of this Act and the regulations:

the service is taken to have been rendered by the other medical practitioner; and

the service is taken not to have been rendered by the specialist trainee.

determine guidelines for making a decision as to whether a podiatrist is to be accredited; and

from time to time, vary or revoke any guidelines so made.

ensures that a properly qualified person supervises the rendering of the service; and

has personal responsibility for the proper rendering of the service.

(a) a specified health service, or a health service included in a specified class of health services, being a health service not specified in an item in the table, shall, or shall in specified circumstances, be treated, for the purposes of specified provisions of this Act, the regulations, the National Health Act 1953 or the regulations under that Act, as if:

the health service were whichever of the following is specified in the determination, namely:

(A) both a professional service and a medical service;

(B) a medical service; and

there were an item in the general medical services table, the pathology services table or the diagnostic imaging services table that:

(A) related to the health service; and

(B) specified in respect of the health service a fee in relation to a State, being the fee and the State specified in the determination in relation to the health service; and

a specified provision of the regulations, a specified instrument made under or given pursuant to this Act or a specified provision of a specified instrument made under or given pursuant to this Act, being a provision or instrument, as the case may be, in which all or any of the following are specified, namely, a professional service, medical service or item, shall, or shall in specified circumstances, have effect as if:

the health service; or

the item that, by virtue of subparagraph (a)(ii), relates to the health service;

as the case requires, were also specified in the provision or instrument, as the case may be.

dental treatment; and

(b) a health service described in paragraph (d) of the definition of health service.

health service means:

medical, surgical, obstetric, dental or optometrical treatment; and

any other prescribed service, or service included in a prescribed class of services, whether or not related to treatment referred to in paragraph (a), that relates to health; and

the supply of prostheses in connection with dental treatment;

but does not include the supply of any other prostheses.

service includes the supply of goods.

is domiciled in Australia; and

is a fellow of a relevant organisation in relation to the specialty (other than general practice); and

has obtained, as a result of successfully completing an appropriate course of study, a relevant qualification in relation to the relevant organisation.

a relevant organisation in relation to the specialty gives the Chief Executive Medicare written notice stating that the medical practitioner no longer meets the criteria for the specialty, or has ceased to practise medicine in Australia; or

the medical practitioner requests that he or she cease to be so recognised.

the medical practitioner is domiciled in Australia; and

the medical practitioner is registered under the National Law as a specialist in a particular specialty (other than general practice).

determine that the medical practitioner be recognised, for the purposes of this Act, as a specialist or consultant physician (as the case requires) in the specialty; and

notify the medical practitioner, in writing, of his or her recognition as a specialist or consultant physician in the specialty.

the medical practitioner ceases to be domiciled in Australia; or

the medical practitioner ceases to practise medicine in Australia.

on and from the day specified for the purpose by the Minister in the determination; or

if no such day is specified—on and from the day on which the determination is made.

a body specified in the regulations gives the Chief Executive Medicare written notice stating:

that the applicant is enrolled in, or undertaking, a course or program of a kind specified in the regulations; and

the period over which, and the location in which, the applicant will be undertaking the course or program; or

the applicant is, in accordance with the regulations, eligible for registration under this section;

the Chief Executive Medicare must, within the required period under subsection (6), enter the applicant’s name in the Register, together with the period in respect of which and the location in respect of which the applicant is registered.

if a notice was given to the Chief Executive Medicare under paragraph (5)(a) in connection with the application:

the period of 14 days after the notice was received by the Chief Executive Medicare; or

if the application was made after the notice was received—the period of 14 days after the application was received by the Chief Executive Medicare; or

if no such notice was given—the period of 14 days after the application was received by the Chief Executive Medicare.

the current state of the Register;

additions to the Register;

deletions from the Register.

the medical practitioner requests the Chief Executive Medicare to do so; or

a body specified in regulations made for the purposes of paragraph 3GA(5)(a) gives the Chief Executive Medicare written notice that the medical practitioner (being a person about whom the body gave a notice under paragraph (5)(a)) is not enrolled in, or undertaking, the course or program in relation to which he or she was registered; or

the regulations require that the medical practitioner’s name be removed from the Register.

items of medical services;

the amount of fees applicable in respect of each item;

rules for interpretation of the table.

a person renders a professional service; and

a claim is made for an amount to be paid under this Act in respect of the service; and

the service is specified in an item in the general medical services table; and

the item mentions the creation (however described) of a document; and

the document is created by the person;

the person must retain the document for the period of 2 years beginning on the day the service is rendered.

that service; and

at least one other service, which may be a diagnostic imaging service or a pathology service;

are provided to the same patient.

that service; and

at least one other medical service, which may be a service other than a diagnostic imaging service;

are provided to the same patient.

unconditional; or

subject to such conditions, limitations or restrictions as are specified in:

the item; or

the rules for interpretation of the table.

holds a prescribed kind of temporary visa; or

holds a prescribed kind of temporary visa and is a member of a class of persons prescribed for the purposes of this section;

is, subject to the regulations, to be treated as an eligible person for the purposes of this Act while he or she is in Australia.

the periods within which a person is to be treated as an eligible person;

the circumstances in which a person is to be treated as an eligible person;

the professional services in relation to which the person is to be treated as an eligible person;

the professional services in relation to which the person is not to be treated as an eligible person.

(a) after the first time in the safety-net year that a member of the family receives a payment of an instalment of family tax benefit under A New Tax System (Family Assistance) (Administration) Act 1999 that has a Part A rate that is greater than nil; orsection 23 of the

(b) after a member of the family receives a payment of family tax benefit under A New Tax System (Family Assistance) (Administration) Act 1999 that has a Part A rate that is greater than nil and that is in respect of the last income year (within the meaning of that Act) ending before the start of the safety-net year; orsection 24 of the

if a determination for the purposes of this paragraph is in force under section 8A—after the time specified in, or worked out in accordance with, the determination.

FTB(A) safety-net amount means $500.

patient contribution means an amount equal to the difference between: the Schedule fee or, if the medical expenses in respect of the service are less than that fee, those expenses; and the amount of benefit that, apart from section 10AC, 10ACA, 10AD or 10ADA (whichever is appropriate), would be payable in respect of the service, disregarding section 19AD.

the Schedule fee or, if the medical expenses in respect of the service are less than that fee, those expenses; and

the amount of benefit that, apart from section 10AC, 10ACA, 10AD or 10ADA (whichever is appropriate), would be payable in respect of the service, disregarding section 19AD.

registered family means a family registered under section 10AA.

safety-net amount means $246.

Schedule fee means the fee specified in the table in respect of the service.

service means a professional service.

such a journey that, when it began, was intended to end at a place outside Australia; and

such a journey that is a part of a longer journey ending, or intended to end, at a place outside Australia; and

such a journey that is part of a longer journey that began outside Australia.

in the case of a service provided:

as part of an episode of hospital treatment; or

as part of an episode of hospital-substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer;

an amount equal to 75% of the Schedule fee; or

in the case of a service to which paragraph (a) does not apply and that is prescribed by the regulations for the purposes of this paragraph—an amount equal to 100% of the Schedule fee; or

in any other case—an amount equal to 85% of the Schedule fee.

the person’s spouse;

any dependent child of the person or of the person’s spouse.

the person is a child; and

the person is a dependent child in relation to persons in more than one registered family.

is under 16; or

is a student child.

dependent child, in relation to any person, means:

a child under 16 who is:

in the custody, care and control of that person; or

where no other person has the custody, care and control of the child—is wholly or substantially in the care and control of the first-mentioned person; or

a student child who is wholly or substantially dependent on the person.

spouse, in relation to a person, means:

a person who is legally married to, and is not living, on a permanent basis, separately and apart from, that person; and

a de facto partner of the person who is not living, on a permanent basis, separately and apart from the person.

student child means a person who:

is 16 or more, but under 25; and

is receiving full-time education at a school, college or university.

a family is registered; and

a person becomes a family member after it is so registered; and

the family’s registration is varied by the addition of the new family member;

then:

claims in respect of his or her medical expenses incurred during the calendar year in which the registration is varied but before the variation may be taken into account for the purposes of section 10AC or 10ACA as if the person had, at all times during that year, been a member of the registered family; but

increased benefits are not payable under that section in relation to medical expenses that are incurred in respect of that person or any other family member and in respect of which benefit has already been paid.

a family is registered; and

a person ceases to be a family member after it is so registered; and

the family’s registration is varied by the deletion of the person; and

the family members (including the person referred to in paragraph (b)) have not, at the time of the variation, become entitled under section 10AC or 10ACA to increased benefits in respect of medical expenses incurred in the calendar year in which the variation is made;

claims in respect of his or her medical expenses incurred during that year may be dealt with separately under sections 10AD and 10ADA, or, if the person becomes a member of another registered family, dealt with under sections 10AC and 10ACA.

a family is registered; and

the family members become entitled under section 10AC or 10ACA to increased benefits in respect of medical expenses incurred in a year; and

a person ceases to be a family member after the family members become so entitled and during that year; and

the family’s registration is varied by the deletion of the person;

then:

claims in respect of his or her medical expenses incurred at any time during that year are to be dealt with under sections 10AC and 10ACA, as if he or she had remained a family member throughout the year; and

despite any other provision of this Act and despite the variation, the person is not entitled to be treated as a member of another registered family during the year.

in respect of which benefit is payable; and

the medical expenses in respect of which exceed the amount of benefit that, apart from this section, would be payable in respect of the service;

but does not include a service rendered to a person while hospital treatment, or hospital-substitute treatment in respect of which the person chooses to receive a benefit from a private health insurer, is provided to the person, being a service of that kind provided on or after 1 September 1985.

year means the year beginning on 1 January 1992 or a later year beginning on 1 January.

(a) a claim (in this subsection called the threshold claim) for benefit is made by a claimant in respect of a relevant service:

which was rendered to the claimant or to a member of the claimant’s registered family; and

in respect of which the medical expenses are incurred in a year;

and the claim is accepted by the Chief Executive Medicare; and

(b) other claims (in this subsection called prior claims) have been made for benefit in respect of relevant services:

which were rendered to any member of the family; and

in respect of which the medical expenses were incurred during the year;

and the prior claims were accepted for payment by the Chief Executive Medicare before the time when the threshold claim was accepted for payment (in this subsection called the relevant time); and

the Chief Executive Medicare is satisfied at the relevant time that:

the medical expenses of the services relating to the threshold claim and to some or all of the prior claims have been paid; and

the sum of the patient contributions that have been paid in respect of those prior claims is less than the safety-net amount for that year; and

the sum of the patient contribution in respect of the threshold claim and the patient contributions referred to in subparagraph (ii) is equal to or exceeds the safety-net amount;

the benefit payable in respect of a relevant service rendered to any of the family and in respect of which medical expenses were incurred in respect of that year (being the service to which the threshold claim relates or any service that is not the subject of a prior claim referred to in paragraph (b)) is increased by the amount of the patient contribution in respect of that relevant service.

if the Chief Executive Medicare is satisfied that a medical expense incurred at that time in respect of the child has been incurred by an adult belonging to one or other of the families—that expense is to be treated, for the purposes of this Act, as an expense incurred in respect of the child as a member of that family; and

if the Chief Executive Medicare is not so satisfied—the expense is to be treated as an expense of which half was incurred in respect of the child as a member of one family and half in respect of the child as a member of the other family.

if a person to whom benefit is payable in respect of a relevant service is given or sent a cheque under subsection 20(2) or (2A) for the amount of the benefit, the person is taken to have paid so much of the medical expenses in respect of that service as is represented by the amount of the benefit; and

despite anything else in this Act, the question when medical expenses are incurred in respect of services relating to prescribed items is to be determined under the regulations.

in respect of which benefit is payable; and

the medical expenses in respect of which exceed the amount of benefit that, apart from this section, would be payable in respect of the service;

but does not include a service rendered to a person while hospital treatment, or hospital-substitute treatment in respect of which the person chooses to receive a benefit from a private health insurer, is provided to the person.

year means a calendar year.

the medical expenses incurred in respect of a relevant service for which the claim is made;

reduced by:

any amounts payable under any other section of this Act in respect of those expenses.

the current claim is a claim that is made by a claimant for a benefit in respect of a relevant service which was rendered to the claimant or to a member of the claimant’s registered family; and

(b) the medical expenses incurred in respect of the relevant service are incurred in a year (the expense year); and

the claimant has paid at least 20% of the out-of-pocket expenses for the service directly to the person by whom, or on whose behalf, the service was rendered; and

the current claim is accepted by the Chief Executive Medicare; and

one or more of the following apply to the claim:

the person to whom the service was rendered is a concessional person in relation to the expense year at the time that the claim is made and the concessional safety-net applies to the current claim;

the person to whom the service was rendered is a member of an FTB(A) family in relation to the expense year at the time that the claim is made and the FTB(A) safety-net applies to the current claim;

the extended general safety-net applies to the current claim.

the claim has been made for benefit in respect of relevant services which were rendered to:

for the concessional safety-net—any member of the family who is a concessional person in relation to the expense year at the time that the current claim is made; and

for the FTB(A) safety-net or the extended general safety-net—any person who is a member of the family at the time that the current claim is made; and

the claim is related to medical expenses incurred during the expense year; and

the claim was accepted for payment by the Chief Executive Medicare before the time when the current claim was accepted for payment; and

the Chief Executive Medicare is satisfied at the time when the current claim was accepted for payment that the out-of-pocket expenses for the claim have been paid.

this section applies to the current claim; but

the sum of the out-of-pocket expenses for all relevant prior claims for the expense year is less than the applicable safety-net amount;

the benefit payable in respect of the claim is not increased under subsection (2) but is instead increased by the amount worked out using the formula:

where:

balance of safety-net means the amount by which the sum of the out-of-pocket expenses for all relevant prior claims for the expense year is less than the applicable safety-net amount.

(a) 2 or more services (the original services) that are each specified in an item are deemed to constitute, or are treated as, one service (the deemed service) under this Act (other than a provision of this Act prescribed by the regulations); and

all of the items in which the original services are specified are items determined under section 10B to be items to which subsection (7A) of this section applies; and

the current claim is for the deemed service;

then, despite subsections (2) and (7) of this section, the increase under this section in the benefit payable in respect of the claim cannot exceed the sum of the amounts determined under section 10B as the maximum increases for those items.

for the purposes of the pathology services table:

2 or more pathology services are treated as a single pathology service; and

the fee for the single service is the fee specified in one or more particular items in the table; and

(b) one or more of those particular items (the limited increase items) are items determined under section 10B to be items to which subsection (7A) of this section applies;

then, for the purposes of that subsection, the single service is taken to be specified in the limited increase item or, if there are 2 or more limited increase items, in the one of those items for which the maximum increase determined under section 10B is the greatest.

(a) a claim (in this subsection called the threshold claim) for benefit is made by a claimant in respect of a relevant service:

which was rendered to the claimant; and

in respect of which the medical expenses are incurred by the claimant in a year;

and the claim is accepted by the Chief Executive Medicare; and

(b) the claimant has made other claims (in this subsection called the prior claims) for benefit in respect of relevant services:

which were rendered to the claimant; and

in respect of which the medical expenses were incurred in that year;

and the prior claims were accepted for payment by the Chief Executive Medicare before the time when the threshold claim was accepted for payment (in this subsection called the relevant time); and

the Chief Executive Medicare is satisfied at the relevant time that:

the medical expenses of the services relating to the threshold claim and some or all of the prior claims have been paid; and

the sum of the patient contributions that have been paid in respect of those prior claims is less than the safety-net amount for that year; and

the sum of the patient contribution in respect of the threshold claim and the patient contributions referred to in subparagraph (ii) is equal to or exceeds the safety-net amount;

the benefit payable in respect of a relevant service rendered to the claimant and in respect of which medical expenses were incurred in respect of that year (being the service to which the threshold claim relates or any service that is not the subject of a prior claim referred to in paragraph (b)) is increased by the amount of the patient contribution in respect of that service.

if a person to whom benefit is payable in respect of a relevant service is given or sent a cheque under subsection 20(2) or (2A) for the amount of the benefit, the person is taken to have paid so much of the medical expenses in respect of that service as is represented by the amount of the benefit; and

despite anything else in this Act, the question when medical expenses are incurred in respect of relevant services relating to prescribed items is to be determined under the regulations.

the medical expenses incurred in respect of a relevant service for which the claim is made;

reduced by:

any amounts payable under any other section of this Act in respect of those expenses.

the current claim is a claim that is made by the person for a benefit in respect of a relevant service which was rendered to the person; and

(b) the medical expenses incurred in respect of the relevant service are incurred in a year (the expense year); and

the person has paid at least 20% of the out-of-pocket expenses for the service directly to the person by whom, or on whose behalf, the service was rendered; and

the current claim is accepted by the Chief Executive Medicare; and

one or more of the following apply to the claim:

the person is a concessional person in relation to the expense year at the time that the claim is made and the concessional safety-net applies to the current claim;

the extended general safety-net applies to the current claim.

the claim has been made for benefit in respect of relevant services which were rendered to the person; and

the claim is related to medical expenses incurred during the expense year; and

the claim was accepted for payment by the Chief Executive Medicare before the time when the current claim was accepted for payment; and

the Chief Executive Medicare is satisfied at the time when the current claim was accepted for payment that the out-of-pocket expenses for the claim have been paid.

this section applies to the current claim; but

the sum of the out-of-pocket expenses for all relevant prior claims for the expense year is less than the applicable safety-net amount;

the benefit payable in respect of the claim is not increased under subsection (3) but is instead increased by the amount worked out using the formula:

where:

balance of safety-net means the amount by which the sum of the out-of-pocket expenses for all relevant prior claims for the expense year is less than the applicable safety-net amount.

(a) 2 or more services (the original services) that are each specified in an item are deemed to constitute, or are treated as, one service (the deemed service) under this Act (other than a provision of this Act prescribed by the regulations); and

all of the items in which the original services are specified are items determined under section 10B to be items to which subsection (8A) of this section applies; and

the current claim is for the deemed service;

then, despite subsections (3) and (8) of this section, the increase under this section in the benefit payable in respect of the claim cannot exceed the sum of the amounts determined under section 10B as the maximum increases for those items.

for the purposes of the pathology services table:

2 or more pathology services are treated as a single pathology service; and

the fee for the single service is the fee specified in one or more particular items in the table; and

(b) one or more of those particular items (the limited increase items) are items determined under section 10B to be items to which subsection (8A) of this section applies;

then, for the purposes of that subsection, the single service is taken to be specified in the limited increase item or, if there are 2 or more limited increase items, in the one of those items for which the maximum increase determined under section 10B is the greatest.

the composition of the family remains, or (if the year has already ended) remained, in that year, as originally registered under section 10AA; or

if, after the registration, the Chief Executive Medicare has been notified of a change in the family composition—the composition of the family remains, or (if that year has already ended) remained, in that year, as last notified to the Chief Executive Medicare.

for the purpose of the indexation of the amount of the greatest permissible gap—the year beginning on 1 November 1992 or a later year beginning on 1 November; or

for the purpose of the indexation of the safety-net amount—the year beginning on 1 January 1993 or a later year beginning on 1 January; or

for the purpose of the indexation of the concessional safety-net amount, the FTB(A) safety-net amount and the extended general safety-net amount—the year beginning on 1 January 2007 or a later year beginning on 1 January.

the amount worked out by multiplying the amount to be indexed by the indexation factor for that amount; or

if the amount worked out under paragraph (a) is not a multiple of 10 cents—that amount rounded down to the nearest multiple of 10 cents.

determine that subsections 10ACA(7A) and 10ADA(8A) apply to specified items;

determine amounts as the maximum increases for items to which subsections 10ACA(7A) and 10ADA(8A) are determined to apply.

the rendering of the professional service is covered by an agreement between a private health insurer and another person; and

the amount payable under the agreement for the professional service is not determined on a fee for service basis.

the amount specified in those items as fees, other than the greater or greatest of those amounts, shall be deemed to be reduced, as follows:

the greater or greatest of the amounts to be deemed to be reduced shall be deemed to be reduced by one-half; and

the other amount, or each of the other amounts, to be deemed to be reduced shall be deemed to be reduced by three-quarters; and

the operations shall be deemed to constitute one professional service in respect of which the fee specified in the table in relation to the State in which the service was rendered is an amount equal to the aggregate of the amounts specified as fees in the items relating to those operations, being those amounts as reduced in accordance with paragraph (a).

where two or more amounts referred to in that subsection are equal, one of those amounts shall be treated as being greater than the other or others of those amounts; and

where, by virtue of a reduction in accordance with that subsection, an amount is not a multiple of 5 cents, the amount of cents shall be increased to the nearest higher amount that is a multiple of 5 cents.

did not perform, or assist at, the other operation or any of the other operations; and

did not administer the anaesthetic.

assistance at an operation;

the administration of an anaesthetic; or

assistance in the administration of an anaesthetic;

the amount of medicare benefit payable in respect of that professional service is the same whether the assistance is rendered, or the anaesthetic is administered, by one or more than one practitioner.

(a) the service (whether a pathologist-determinable service or not) was determined to be necessary by a practitioner (in this section referred to as the treating practitioner) whose patient the person was; or

the service (whether a pathologist-determinable service or not) was:

(i) determined to be necessary by a participating midwife (in this section also referred to as the treating practitioner), acting in his or her capacity as a participating midwife, whose patient the person was; and

a service of a kind specified in regulations made for the purposes of this subparagraph; or

the service (whether a pathologist-determinable service or not) was:

(i) determined to be necessary by a participating nurse practitioner (in this section also referred to as the treating practitioner), acting in his or her capacity as a participating nurse practitioner, whose patient the person was; and

a service of a kind specified in regulations made for the purposes of this subparagraph; or

the service was:

a pathologist-determinable service rendered by or on behalf of an approved pathology practitioner; and

determined to be necessary by that approved pathology practitioner.

the service was rendered by or on behalf of an approved pathology practitioner;

the service was rendered in an accredited pathology laboratory and was a service of a kind in respect of which the laboratory was accredited;

the proprietor of the laboratory was an approved pathology authority;

there was no other proprietor of the laboratory; and

either:

the approved pathology practitioner by whom or on whose behalf the service was rendered was the proprietor of the laboratory; or

the service was rendered in the laboratory under an agreement (whether by way of contract of employment or otherwise) between:

(A) the approved pathology practitioner by whom or on whose behalf the pathology service was rendered; and

(B) the proprietor of the laboratory.

the service was rendered pursuant to a request made by the treating practitioner and, if an approved pathology practitioner was specified on the request, the service was conducted by that practitioner; or

the service was rendered pursuant to a request made by another approved pathology practitioner who received a request for the service made by the treating practitioner and the treating practitioner did not specify a pathology practitioner.

the request is:

made in writing; or

if made otherwise than in writing—confirmed in writing within the period of 14 days commencing on the day on which the request is made; and

the request is made in accordance with the regulations (if any).

the treating practitioner; or

(b) another approved pathology practitioner (in subsection (5AB) called the referring pathologist) who received a request for the service made by the treating practitioner;

unless the pathology specimen required for the rendering of the service:

was collected from the person:

by the person himself or herself; or

by the treating practitioner; or

on behalf of the treating practitioner, by an employee of, or by a person engaged under a contract for services by or on behalf of, the treating practitioner; or

if the treating practitioner is employed, or engaged under a contract for services, by a medical entrepreneur—on behalf of the treating practitioner, by another employee of that medical entrepreneur, or by a person engaged under a contract for services by or on behalf of that medical entrepreneur; or

was collected from the person by a person to whom this paragraph applies at:

the place where the person was residing; or

an approved collection centre (within the meaning of Part IIA); or

premises of a recognised hospital, being premises at which hospital treatment is provided; or

a private hospital in which the person is a patient; or

(v) a residential care home (within the meaning of the Aged Care Act 2024), or other institution, in which the person is receiving care; or

was collected from the person by:

a member of the staff of a hospital in which the person is a patient; or

(ii) a member of the staff of a residential care home (within the meaning of the Aged Care Act 2024), or other institution, in which the person is receiving care.

(5AB) Paragraph (5AA)(d) applies to:

the rendering pathologist; and

the referring pathologist (if any); and

an employee of an approved pathology authority that is the proprietor of the laboratory in which the service is to be rendered; and

an employee of an approved pathology authority from which the pathology specimen in question was referred to:

an approved pathology authority to which paragraph (c) applies; or

an approved pathology practitioner who is to render the service in a laboratory of which such an approved pathology authority is the proprietor.

the request for the service was made:

(i) by the treating practitioner (the requesting practitioner); or

(ii) by another approved pathology practitioner (the requesting practitioner) who received a request for the service made by the treating practitioner; and

the request for the service was made as a result of:

conduct in respect of which the approved pathology practitioner or the requesting practitioner has been convicted of an offence under Division 3 of Part IIBA; or

conduct in respect of which the approved pathology practitioner or the requesting practitioner has been ordered to pay a pecuniary penalty under Part VIA.

the medical practitioner by whom or on whose behalf the service is rendered is the treating practitioner; or

the medical practitioner by whom or on whose behalf the service is rendered:

is a member of a group of practitioners of which the treating practitioner is a member; and

is requested by the treating practitioner to render the service.

the service is a prescribed pathology service that is rendered by a participating midwife or a participating nurse practitioner; and

the participating midwife or participating nurse practitioner by whom the service is rendered is the treating practitioner; and

the service is specified in the determination made under section 4BB as a service to which this subsection applies if rendered by a participating midwife or participating nurse practitioner (as the case requires); and

if that determination specifies circumstances in which the service must be rendered to be a pathology service to which this subsection applies—the service is rendered in those circumstances.

a practitioner conducts a medical practice or a dental practice; and

another practitioner, or other practitioners, participate (whether as employees or otherwise) in the provision of professional services as part of that practice;

the practitioner referred to in paragraph (a) and the practitioner or practitioners referred to in paragraph (b) shall be taken, for the purposes of this section, to constitute a group of practitioners.

a reference to a request made in writing or to a confirmation in writing of a request shall be read as including a reference to a request or a confirmation, as the case may be, in such other form as the Minister approves, in writing, from time to time; and

a reference to determining that a service is necessary is a reference to determining that a service is reasonably necessary for the adequate medical care of the patient concerned.

where the service is one for which there is a corresponding NR-type diagnostic imaging service:

the providing practitioner is a consultant physician, or a specialist, in a particular specialty; and

the service was rendered by or on behalf of the providing practitioner in the course of the providing practitioner practising that specialty; and

the service was rendered pursuant to a written request made by:

another medical practitioner; or

subject to subsection (2), a dental practitioner; or

subject to subsection (3), a chiropractor; or

subject to subsection (3A), a physiotherapist; or

subject to subsection (3B), a podiatrist; or

subject to subsection (3C), an osteopath; or

subject to subsection (3D), a participating midwife; or

subject to subsection (3E), a participating nurse practitioner;

who determined that the service was necessary and whose patient the person was.

Dental practitioners may only request certain services

the request need not be addressed to a particular practitioner; and

where it is so addressed—the service need not be rendered by or on behalf of that practitioner.

Request may be for more than one service

the providing practitioner is a consultant physician, or a specialist, in a particular specialty (other than the specialty of diagnostic radiology); and

the service was rendered by or on behalf of the providing practitioner in the course of the providing practitioner practising that specialty; and

the providing practitioner determined that the service was necessary.

Remote area exemption

the service is not one for which there is a corresponding NR-type diagnostic imaging service; and

the service was rendered within an area that is a remote area for the purposes of Division 2 of Part IIB; and

the service was rendered during the period when a remote area exemption granted to the providing practitioner under section 23DX was in force; and

if the remote area exemption in force in relation to the practitioner was restricted under subsection 23DY(1) to certain R-type diagnostic imaging services—the service is one of those R-type diagnostic imaging services; and

either:

the service was rendered before the end of one month (or such further period as the Chief Executive Medicare allows) after the commencement of this paragraph; or

the service was rendered after the end of that period at a time when the practitioner was registered as a participating practitioner in the Register of Participating Practitioners maintained under section 23DSC.

Exemption—emergencies

the person in relation to whom the service was rendered, or a person acting on that person’s behalf, claimed that a medical practitioner, dental practitioner, chiropractor, physiotherapist, podiatrist, osteopath, participating midwife or participating nurse practitioner, had made a request for the service to be rendered, but that the request had been lost; and

(b) the providing practitioner, or an employee or agent of the providing practitioner, had sought and received from the medical practitioner, dental practitioner, chiropractor, physiotherapist, podiatrist, osteopath, participating midwife or participating nurse practitioner, (in this subsection called the requesting practitioner) who was claimed to have made the request, or from an employee or agent of the requesting practitioner, confirmation that the request had been made; and

if the requesting practitioner is a dental practitioner who made the request in his or her capacity as a dental practitioner—the request is not rendered ineffective by the operation of subsection (2); and

if the requesting practitioner is a chiropractor who made the request in his or her capacity as a chiropractor—the request is not rendered ineffective by the operation of subsection (3); and

if the requesting practitioner is a physiotherapist who made the request in his or her capacity as a physiotherapist—the request is not rendered ineffective by the operation of subsection (3A); and

if the requesting practitioner is a podiatrist who made the request in his or her capacity as a podiatrist—the request is not rendered ineffective by the operation of subsection (3B); and

if the requesting practitioner is an osteopath who made the request in his or her capacity as an osteopath—the request is not rendered ineffective by the operation of subsection (3C); and

if the requesting practitioner is a participating midwife who made the request in his or her capacity as a participating midwife—the request is not rendered ineffective by the operation of subsection (3D); and

if the requesting practitioner is a participating nurse practitioner who made the request in his or her capacity as a participating nurse practitioner—the request is not rendered ineffective by the operation of subsection (3E).

Exemption—additional services

(a) the diagnostic imaging service (the additional service) was rendered in relation to the person because the providing practitioner formed the opinion that the results obtained from the rendering of another diagnostic imaging service in relation to the person, pursuant to a subsection 16B(1) request, indicate that the additional service is necessary; and

the additional service is a service in relation to which a medicare benefit is payable (or would be payable if section 19AD were disregarded) regardless of whether the service is rendered on the request of a specialist or a consultant physician.

Exemption—substituted services

(a) the diagnostic imaging service (the substituted service) was rendered in relation to the person in substitution for another service for which a subsection 16B(1) request has been made; and

(b) the substituted service was rendered because the providing practitioner formed the opinion that it would be more appropriate in the diagnosis of the person’s condition to render the substituted service than the service requested; and

(c) the substituted service would be accepted by the general body of specialists or consultant physicians in the specialty practised by the providing practitioner as more appropriate in the diagnosis of the person’s condition than the service requested; and

before providing the substituted service, the providing practitioner has either consulted the person who made the subsection 16B(1) request, or taken all reasonable steps to consult that person; and

the substituted service is a service in relation to which a medicare benefit is payable (or would be payable if section 19AD were disregarded) regardless of whether the service is rendered on the request of a specialist or a consultant physician.

Exemption—pre-existing diagnostic imaging practices

the service is a service of a kind specified in regulations made for the purposes of this subsection; and

the service was rendered by or on behalf of the providing practitioner in the course of treating his or her own patient; and

the providing practitioner determined that the service was necessary; and

either:

the service was rendered before the end of one month (or such further period as the Chief Executive Medicare allows) after the commencement of this paragraph; or

the service was rendered after the end of that period at a time when the practitioner was registered as a participating practitioner in the Register of Participating Practitioners maintained under section 23DSC; and

during the period commencing on 17 October 1988 and ending on 16 October 1990, at least 50 services had been rendered by or on behalf of the providing practitioner, each being a service that:

would have been an R-type diagnostic imaging service if it had been rendered after the commencement of this section; and

was rendered at the location at which the first-mentioned service was rendered; and

resulted in the payment of a medicare benefit.

carried out using diagnostic imaging equipment that:

is ordinarily located at registered diagnostic imaging premises; and

is of a type that, on the day on which the procedure is carried out, is listed for the premises; or

carried out using diagnostic imaging equipment that:

is ordinarily located at a registered base for mobile diagnostic imaging equipment when not in use; and

is not ordinarily located at diagnostic imaging premises; and

is of a type that, on the day on which the procedure is carried out, is listed for the base.

Meaning of registered diagnostic imaging premises and registered base for mobile diagnostic imaging equipment

the Diagnostic Imaging Register states that equipment of a particular type is ordinarily located at the premises; and

the equipment is of that type.

the Diagnostic Imaging Register states that pieces of equipment of a particular type are ordinarily located at the base when not in use and not ordinarily located at diagnostic imaging premises; and

the equipment is of that type.

Some circumstances in which diagnostic imaging equipment is taken to be ordinarily located at diagnostic imaging premises

the equipment is:

on trial at the premises for a period of not more than 3 months; and

of the same type as equipment listed for the premises during the period of the trial; or

each of the following circumstances exist:

(i) the equipment (the substituted equipment) is used, for a period of not more than 3 months, in substitution for diagnostic imaging equipment that is not in operation;

the substituted equipment is of the same type as the equipment that is not in operation;

the equipment that is not in operation is ordinarily located at the premises.

the equipment is:

on trial through the base for a period of not more than 3 months; and

not ordinarily located, or taken to be ordinarily located, at diagnostic imaging premises during the period of the trial; and

of the same type as equipment listed for the base during the period of the trial; or

each of the following circumstances exist:

(i) the equipment (the substituted equipment) is used, for a period of not more than 3 months, in substitution for diagnostic imaging equipment that is not in operation;

the substituted equipment is of the same type as the equipment that is not in operation;

the equipment that is not in operation is ordinarily located at the base when not in use and not ordinarily located at diagnostic imaging premises.

at diagnostic imaging premises that are, or at a base for mobile diagnostic imaging equipment that is, accredited for that procedure under a diagnostic imaging accreditation scheme; or

using diagnostic imaging equipment that:

when not in use, is ordinarily located at a base for mobile diagnostic imaging equipment that is accredited for that procedure under a diagnostic imaging accreditation scheme; and

is not ordinarily located at diagnostic imaging premises; or

using diagnostic imaging equipment that is ordinarily located at diagnostic imaging premises that are accredited for that procedure under a diagnostic imaging accreditation scheme.

rendered using radiation oncology equipment that:

is ordinarily located at registered radiation oncology premises; and

is of a type that, on the day on which the service is rendered, is listed for the premises; or

rendered using radiation oncology equipment that:

is ordinarily located at a registered base for mobile radiation oncology equipment when not in use; and

is not ordinarily located at radiation oncology premises; and

is of a type that, on the day on which the service is rendered, is listed for the base.

Meaning of radiation oncology service

the Radiation Oncology Register states that equipment of a particular type is ordinarily located at the premises; and

the equipment is of that type.

the Radiation Oncology Register states that pieces of equipment of a particular type are ordinarily located at the base when not in use and not ordinarily located at radiation oncology premises; and

the equipment is of that type.

Some circumstances in which radiation oncology equipment is taken to be ordinarily located at radiation oncology premises

the equipment is:

on trial at the premises for a period of not more than 3 months; and

of the same type as equipment listed for the premises during the period of the trial; or

each of the following circumstances exist:

(i) the equipment (the substituted equipment) is used, for a period of not more than 3 months, in substitution for radiation oncology equipment that is not in operation;

the substituted equipment is of the same type as the equipment that is not in operation;

the equipment that is not in operation is ordinarily located at the premises.

the equipment is:

on trial through the base for a period of not more than 3 months; and

not ordinarily located, or taken to be ordinarily located, at radiation oncology premises during the period of the trial; and

of the same type as equipment listed for the base during the period of the trial; or

each of the following circumstances exist:

(i) the equipment (the substituted equipment) is used, for a period of not more than 3 months, in substitution for radiation oncology equipment that is not in operation;

the substituted equipment is of the same type as the equipment that is not in operation;

the equipment that is not in operation is ordinarily located at the base when not in use and not ordinarily located at radiation oncology premises.

the medical expenses in respect of that service have been paid, or are payable, to a recognized hospital;

the medical practitioner who rendered the service was acting on behalf of an organization that was, when the service was rendered, an organization prescribed for the purposes of this paragraph;

any part of the service was rendered on the premises of an organization that was, when the service was rendered, an organization referred to in paragraph (b); or

any amount has been paid, or is payable, in respect of the service in accordance with a scheme to which section 42B applies.

life insurance;

superannuation or provident account schemes; or

admission to membership of a friendly society.

the Commonwealth;

a State;

a local governing body; or

an authority established by a law of the Commonwealth, a law of a State or a law of an internal Territory.

the medical expenses in respect of that professional service were incurred by the employer of that person; or

the person to whom that professional service was rendered was employed in an industrial undertaking and that professional service was rendered to him or her for purposes connected with the operation of that undertaking.

first became a registered medical practitioner on or after 1 November 1996; and

was not, at the time the service was rendered:

a specialist (whether or not the service was rendered in the performance of the specialist’s specialty); or

a consultant physician (whether or not the service was rendered in the performance of the consultant physician’s specialty); or

a general practitioner; or

subject to subsection (3), a person registered under section 3GA; or

(v) a person who is covered by an exemption under subsection 19AB(3), being a person who is neither an Australian citizen nor a permanent resident within the meaning of the Migration Act 1958.

first became a registered medical practitioner on or after 1 November 1996; and

was not, at the time the service was rendered:

a specialist (whether or not the service was rendered in the performance of the specialist’s specialty); or

a consultant physician (whether or not the service was rendered in the performance of the consultant physician’s specialty); or

a general practitioner; or

subject to subsection (3), a person registered under section 3GA; or

(v) a person who is covered by an exemption under subsection 19AB(3), being a person who is neither an Australian citizen nor a permanent resident within the meaning of the Migration Act 1958.

during the period in respect of which, and in the location in respect of which, the person is registered under section 3GA; or

in such other circumstances (which may include circumstances relating to the period during which, or the location in which, services are rendered) as are specified in the regulations.

(a) was a registered medical practitioner who had not commenced, or who had not completed, training as an intern; or

(b) was not an Australian citizen or a permanent resident within the meaning of the Migration Act 1958;

is taken to have first become a registered medical practitioner on 1 November 1996.

a period of internship (by whatever name called); or

a period of supervised training (by whatever name called);

under a law of a State or Territory specified in the regulations (whether or not the registered medical practitioner is a resident in a hospital for some or all of that period).

professional service does not include:

(a) a service of a kind referred to in paragraph (b), (ba) or (c) of the definition of professional service in subsection 3(1); or

a professional service (as defined in subsection 3(1)) that is constituted by assistance at an operation.

registered medical practitioner means a person:

registered under the National Law in the medical profession; or

registered or licensed as a medical practitioner under a law of a State or Territory that provided for the registration or licensing of medical practitioners (within the meaning of that law).

the person first became a registered medical practitioner before 1 January 1997; or

all of the following conditions are satisfied:

the person was, at a time before 1 January 1997, an overseas trained doctor;

before 1 January 1997, the Australian Medical Council received an application from the person to undertake examinations, successful completion of which would ordinarily enable the person to become a registered medical practitioner;

on the day the application was so received, the person was eligible to undertake those examinations under the rules of the Australian Medical Council as in force on the day the application was so received; or

both of the following conditions are satisfied:

the person first became a registered medical practitioner before the commencement of this subparagraph;

the service was rendered after the end of the period of 10 years beginning when the person first became a registered medical practitioner; or

both of the following conditions are satisfied:

the person was a permanent Australian at the time when the person first became a registered medical practitioner;

the service was rendered after the end of the period of 10 years beginning when the person first became a registered medical practitioner; or

both of the following conditions are satisfied:

the person became a permanent Australian after the time when the person first became a registered medical practitioner;

the service was rendered after the end of the period of 10 years beginning when the person first became a registered medical practitioner.

the person first became a registered medical practitioner before 1 January 1997; or

all of the following conditions are satisfied:

the person was, at a time before 1 January 1997, an overseas trained doctor;

before 1 January 1997, the Australian Medical Council received an application from the person to undertake examinations, successful completion of which would ordinarily enable the person to become a registered medical practitioner;

on the day the application was so received, the person was eligible to undertake those examinations under the rules of the Australian Medical Council as in force on the day the application was so received; or

both of the following conditions are satisfied:

the person first became a registered medical practitioner before the commencement of this subparagraph;

the service was rendered after the end of the period of 10 years beginning when the person first became a registered medical practitioner; or

both of the following conditions are satisfied:

the person was a permanent Australian at the time when the person first became a registered medical practitioner;

the service was rendered after the end of the period of 10 years beginning when the person first became a registered medical practitioner; or

both of the following conditions are satisfied:

the person became a permanent Australian after the time when the person first became a registered medical practitioner;

the service was rendered after the end of the period of 10 years beginning when the person first became a registered medical practitioner.

the granting of an exemption under subsection (3); or

assisting the Minister or the Chief Executive Medicare to ascertain whether a condition of such an exemption has been breached;

disclose to the Minister or to an officer of the Department administered by the Minister, or to a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973), information about the conditions on which a person has entered or remains in Australia.

accredited by the Australian Medical Council; and

located in Australia or New Zealand.

foreign graduate of an accredited medical school means a person:

whose primary medical qualification was obtained from an accredited medical school; and

who was not one of the following when he or she first enrolled at an accredited medical school:

a permanent Australian;

a New Zealand citizen;

a permanent resident of New Zealand.

overseas trained doctor means a person whose primary medical qualification was not obtained from an accredited medical school.

permanent Australian means an Australian citizen or a holder of a permanent visa (within the meaning of the Migration Act 1958).

professional service does not include a service of a kind referred to in paragraph (b), (ba) or (c) of the definition of professional service in subsection 3(1).

registered medical practitioner means a person:

registered under the National Law in the medical profession; or

registered or licensed as a medical practitioner under a law of a State or Territory that provided for the registration or licensing of medical practitioners (within the meaning of that law).

a person is or was a party to a contract with the Commonwealth (as represented by the Department) for a Medical Rural Bonded Scholarship (including such a contract as varied from time to time); and

(b) an amount of medicare benefit was purportedly paid in respect of a professional service rendered at a particular time (the service time) by, or on behalf of, the person as a medical practitioner; and

the service time occurred in a period during which a medicare benefit was not payable to the person under subsection 19ABA(1); and

the amount is recoverable as an amount owing to the Commonwealth.

a person is a party to a contract with the Commonwealth (as represented by the Department) for a Medical Rural Bonded Scholarship (including such a contract as varied from time to time) that was entered into before the commencement of this section; and

after the commencement of this section, the person breaches a provision of the contract that requires the person to work in a rural or remote area in accordance with that provision;

the Minister may determine that a medicare benefit is not payable in respect of a professional service rendered by, or on behalf of, the person as a medical practitioner.

starts on the day specified in the determination (which must not be a day before the determination is made); and

ends:

when the period that is equal to double the length of the period that the person was required under the contract to work in a rural or remote area ends; or

if a shorter period is determined in, or in accordance with, the contract—when that shorter period ends.

the decision to make the determination;

the reasons for the decision;

how the person may apply for reconsideration or review of the decision.

be made in writing; and

set out the reasons for the request; and

be given to the Minister within 28 days after the affected person is notified of the original decision.

Reconsideration of original decision

personally reconsider the decision; or

cause the decision to be reconsidered by a delegate of the Minister who:

was not involved in making the decision; and

occupies a position that is at least the same level as that occupied by the person who made the decision.

affirm the decision; or

vary the decision; or

set the decision aside and substitute a new decision.

the decision;

the date the decision takes effect;

the reasons for the decision.

Review by the Administrative Review Tribunal

an upload exception applies in relation to the person sharing the information with the My Health Record system; or

(b) another entity (within the meaning of the My Health Records Act 2012) has shared the information with the My Health Record system; or

(c) a law of a State or Territory prescribed by regulations for the purposes of subsection 41(4) of, or subclause 9(3) of Schedule 1 to, the My Health Records Act 2012 prevents the person or any associate of the person for the service from sharing the information with the My Health Record system; or

(d) the information is specified in My Health Records Rules made for the purposes of paragraph 78A(3)(d) of the My Health Records Act 2012; or

(e) the person or an associate of the person for the service is specified in My Health Records Rules made for the purposes of paragraph 78A(3)(e) of the My Health Records Act 2012; or

the end of the period specified in the upload rules for the purposes of subsection (1) occurs:

during the period starting when the person or an associate of the person for the service applies to the My Health Record System Operator under section 19AE and ending when the application is resolved; or

during a period approved by the My Health Record System Operator under section 19AE in relation to the person or an associate of the person for the service; or

(iii) during any upload suspension period determined under subsection 78A(4) of the My Health Records Act 2012; or

during the period starting when the person or an associate of the person for the service applies to the My Health Record System Operator under section 41B, 42 or 78B of that Act and ending when the application is finally determined (within the meaning of that Act); or

during the period approved by the My Health Record System Operator under section 41B or 78B of that Act in relation to the person or an associate of the person for the service.

(a) the individual is not a registered healthcare recipient (within the meaning of the My Health Records Act 2012); or

either:

the individual, or an authorised representative or nominated representative of the individual, has advised the person or an associate of the person for the service; or

the person or an associate of the person for the service has otherwise been informed that the individual, or an authorised representative or nominated representative of the individual, has advised;

that the information must not be uploaded to the My Health Record system; or

(c) an individual healthcare provider (within the meaning of the My Health Records Act 2012) reasonably believes that the information should not be shared with the My Health Record system because of a serious concern for the health, safety or wellbeing of the individual; or

the information cannot be shared with the My Health Record system due to circumstances beyond the reasonable control of the person and any associate of the person for the service.

(a) the person renders the service as an employee (within the meaning of the My Health Records Act 2012) of the healthcare provider organisation;

(b) another person, as an employee (within the meaning of the My Health Records Act 2012) of the healthcare provider organisation, renders the service on behalf of the person;

the healthcare provider organisation provides support services or facilities to facilitate the rendering of the service by or on behalf of the person;

the circumstances (if any) specified in the upload rules.

a person who renders a professional service for which the person is specified in the upload rules for the purposes of subsection 19AD(1); or

a person on whose behalf a professional service for which the person is specified in the upload rules for the purposes of subsection 19AD(1) is rendered; or

an associate of a person in relation to a professional service for which the person is specified in the upload rules for the purposes of subsection 19AD(1).

Application

be in the form approved, in writing, by the My Health Record System Operator; and

include, or be accompanied by, the information and documents required by the form; and

be lodged at a place, or by a means, specified in the form.

Further information may be required

the entity’s size and technological readiness;

the potential disruption (if any) to the provision of healthcare if the entity does not share information with the My Health Record system;

any other matter the My Health Record System Operator considers relevant.

the original decision is to approve the application; or

(b) no notice of the original decision is given because subsection 97(2A) of the My Health Records Act 2012 applies; or

(c) no notice asking the My Health Record System Operator to reconsider the original decision is given within the period mentioned in subsection 97(4) of the My Health Records Act 2012; or

all of the following apply:

(i) a notice asking the My Health Record System Operator to reconsider the original decision is given within the period mentioned in subsection 97(4) of the My Health Records Act 2012;

the My Health Record System Operator reconsiders the original decision;

(iii) no application is made to the Administrative Review Tribunal within the period mentioned in Administrative Review Tribunal Act 2024 for review of the My Health Record System Operator’s reconsideration decision; orsection 18 of the

(e) an application is made to the Administrative Review Tribunal within the period mentioned in Administrative Review Tribunal Act 2024 for review of the My Health Record System Operator’s reconsideration of the original decision, the Administrative Review Tribunal decides the application and one of the following applies:section 18 of the

subsection 123(1) of that Act does not apply in relation to the Administrative Review Tribunal’s decision;

no application is made under section 123 of that Act within the period mentioned in section 125 of that Act to refer the Administrative Review Tribunal’s decision to the guidance and appeals panel;

any application that is made under section 123 of that Act within the period mentioned in section 125 of that Act to refer the Administrative Review Tribunal’s decision to the guidance and appeals panel is refused; or

both of the following apply:

(i) the President of the Administrative Review Tribunal refers the Administrative Review Tribunal’s decision on the application for review of the My Health Record System Operator’s reconsideration of the original decision to the guidance and appeals panel under Administrative Review Tribunal Act 2024;section 123 of the

the Administrative Review Tribunal makes a decision on the guidance and appeals panel application taken to be made because of the referral.

medicare benefit is payable in respect of a professional service specified in the upload rules for the purposes of subsection 19AD(1); and

medicare benefit would not have been payable in respect of the service if an upload exception had not applied;

the person by or on whose behalf the service was rendered must keep, or ensure another person keeps, for a period of 2 years starting on the day the service was rendered, evidence that an upload exception applied that meets the requirements (if any) specified in the upload rules.

the person in respect of whom the service was rendered; or

the person who incurred the medical expenses in respect of the service.

(a) an amount (a relevant amount) paid under section 19AG on account of an amount that would but for section 19AD be payable under section 10 in respect of a professional service rendered by or on behalf of a person (the service provider); and

(b) an amount (a relevant amount) of medicare benefit paid in respect of a professional service specified in the upload rules for the purposes of subsection 19AD(1) rendered by or on behalf of a person (the service provider) specified for the service in the upload rules for the purposes of that subsection.

the service provider is required, by a notice given under subsection 19AF(3), to produce evidence in relation to the professional service; and

the service provider does not comply with the requirement within the period set out in the notice;

an amount equal to the relevant amount is recoverable as a debt due to the Commonwealth from the service provider or from the estate of the service provider.

the service provider is required, by a notice given under subsection 19AF(3), to produce evidence in relation to the professional service; and

the service provider complies with the requirement within the period set out in the notice; and

the evidence produced does not properly substantiate (wholly or partly) that the relevant amount is payable in accordance with section 19AD;

then, to the extent that the relevant amount is not properly substantiated, that amount is recoverable as a debt due to the Commonwealth from the service provider or from the estate of the service provider.

(a) a person (the notice recipient) other than the service provider is required, by a notice given under subsection 19AF(3), to produce evidence in relation to the professional service; and

the notice recipient complies with the requirement within the period set out in the notice; and

the evidence produced does not properly substantiate (wholly or partly) that the relevant amount is payable in accordance with section 19AD;

then, to the extent that the relevant amount is not properly substantiated, that amount is recoverable as a debt due to the Commonwealth from the service provider or from the estate of the service provider.

create an offence or civil penalty;

provide powers of:

arrest or detention; or

entry, search or seizure;

impose a tax;

set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

directly amend the text of this Act.

at the time when the service was rendered, the person who rendered the service, or the practitioner on whose behalf the service was rendered, was a practitioner:

who was fully disqualified under an agreement that was in effect under section 92; or

who was fully disqualified under section 105; or

in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(h) that the practitioner be fully disqualified was in effect; or

in relation to whom a determination under paragraph 124F(2)(e) or 124FF(2)(d) that the practitioner be fully disqualified was in effect; or

who was taken to be fully disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect; or

at the time when the service was rendered, the person who rendered the service, or the practitioner on whose behalf the service was rendered, was a practitioner:

who was partly disqualified under an agreement that was in effect under section 92 in respect of that service; or

in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified was in effect in respect of that service; or

in relation to whom a determination under paragraph 124F(2)(d) or 124FF(2)(d) that the practitioner be partly disqualified was in effect in respect of that service; or

who was taken to be partly disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect in respect of that service; or

the service was initiated by a person other than the person who rendered the service, and the person who initiated the service, or the practitioner on whose behalf the service was initiated, was a practitioner:

who was fully disqualified under an agreement that was in effect under section 92; or

who was fully disqualified under section 105; or

in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(h) that the practitioner be fully disqualified was in effect; or

in relation to whom a determination under paragraph 124F(2)(e) or 124FF(2)(d) that the practitioner be fully disqualified was in effect; or

who was taken to be fully disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect; or

the service was initiated by a person other than the person who rendered the service, and the person who initiated the service, or the practitioner on whose behalf the service was initiated, was a practitioner:

who was partly disqualified under an agreement that was in effect under section 92 in respect of that service; or

in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified was in effect in respect of that service; or

in relation to whom a determination under paragraph 124F(2)(d) or 124FF(2)(d) that the practitioner be partly disqualified was in effect in respect of that service; or

who was taken to be partly disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect in respect of that service.

a medical practitioner is not authorised under the practitioner’s registration under the National Law to render a particular professional service; and

the medical practitioner renders such a service;

a medicare benefit is not payable in respect of that service, unless the Minister otherwise directs.

a medical practitioner is authorised under the practitioner’s registration under the National Law to render a particular professional service only in particular circumstances; and

the medical practitioner renders such a service in other circumstances;

a medicare benefit is not payable in respect of that service, unless the Minister otherwise directs.

affirm the decision; or

make a decision that benefit is payable in respect of the service.

the terms of the decision and the reasons for it; and

(b) a statement to the effect that, subject to the Administrative Review Tribunal Act 2024, application may be made to the Administrative Review Tribunal for a review of the decision.

is not authorised under the practitioner’s registration under the National Law to render a particular professional service; or

is authorised under the practitioner’s registration under the National Law to render a particular professional service only in particular circumstances;

the Minister may, by instrument in writing served on the practitioner, direct that, with effect from the day specified in the direction, the practitioner must not:

render such a service; or

render such a service in circumstances where the practitioner is not authorised under the practitioner’s registration under the National Law to render the service;

(as the case may be) unless, before rendering the service, the practitioner causes to be given to the patient a notice informing the patient that a medicare benefit will not be payable in respect of the service unless the Minister otherwise directs.

render the particular professional service; or

render the particular professional service in circumstances in which the practitioner was not previously authorised under that registration to render it.

he or she renders to another person a professional service in respect of which a medicare benefit is not payable because of section 19AA, 19AB, 19ABA or 19ABC; and

before the service is rendered, such steps as are reasonable in all the circumstances have not been taken to inform:

the other person; or

if the other person is in the care of someone else—that person;

that a medicare benefit would not be payable.

in a case to which paragraph (b) does not apply—the practitioner or the person acting on his or her behalf causes to be given to the person to whom the professional service is to be rendered or initiated a copy of such notice as is furnished to the practitioner with the instrument, being a notice setting out particulars of the disqualification of the practitioner and explaining such of the effects of that disqualification as the Minister considers appropriate; or

in a case where the practitioner or the person acting on his or her behalf has reasonable grounds for believing that the person to whom the service is to be rendered or initiated is, or may be, unable to read and understand the notice referred to in paragraph (a)—the practitioner or the person acting on his or her behalf causes to be taken such steps as are reasonable in all the circumstances to inform the person, or, if that person is in the care of another person, to inform that other person, of the particulars of the disqualification set out in that notice, and to explain to the person or to that other person, as the case requires, such of the effects of the disqualification as are set out in that notice.

sets out particulars of the disqualification; and

explains such of the effects of the disqualification as the Minister considers appropriate.

refuses or fails to comply with a direction contained in an instrument served on him or her under subsection (1); or

causes or permits a person acting on his or her behalf to refuse or fail to comply with such a direction;

commits an offence punishable upon conviction by a fine not exceeding 1 penalty unit.

in relation to whom a determination under paragraph 124F(2)(d) or (e) or 124FF(2)(d) is in effect; or

who is taken to be disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person is in effect; or

who is disqualified under an agreement that is in effect under section 92; or

who is fully disqualified under section 105; or

in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(g) or (h) is in effect; or

who is fully disqualified for the purposes of this section under section 106ZPM.

patients, in relation to a practitioner, means:

the persons to whom the practitioner or a person acting on behalf of the practitioner has rendered, or in the Minister’s opinion may render, professional services; and

the persons in respect of whom the practitioner or a person acting on behalf of the practitioner has initiated, or in the Minister’s opinion may initiate, professional services.

practitioner has the same meaning as in section 124B.

the person to whom the service is to be rendered; or

if that person is in the care of another person—that other person;

that a medicare benefit would not be payable in respect of the medical service if it were rendered by, or on behalf of, the practitioner.

section 10AC, 10ACA, 10AD or 10ADA applies to a claim for medicare benefit in respect of a professional service; and

the person to whom the medicare benefit is payable under subsection (1) in respect of the professional service has paid a part, but not the whole, of the medical expenses that he or she has incurred in respect of that professional service;

then:

if the medicare benefit is less than, or equal to, the unpaid amount—he or she is not to be paid the medicare benefit but, if he or she so requests, there will, in lieu of that payment, be given to him or her personally, or sent to him or her by post at his or her last-known address, a cheque for the amount of the medicare benefit drawn in favour of the person by whom, or on whose behalf, the professional service was rendered; or

if the medicare benefit exceeds the unpaid amount—he or she is not to be paid so much of the medicare benefit as is equal to the unpaid amount but, if he or she so requests, there will, in lieu of that payment, be given to him or her personally, or sent to him or her by post at his or her last-known address, a cheque for that amount of the medicare benefit drawn in favour of the person by whom, or on whose behalf, the professional service was rendered.

a cheque for an amount of a medicare benefit payable in respect of a professional service is given or sent under subsection (2) or (2A) at the request of the person to whom the medicare benefit is payable; and

the professional service was rendered by or on behalf of a general practitioner, specialist or consultant physician; and

the cheque is not presented for payment during the period of 90 days beginning on the day on which the cheque was given or sent under that subsection;

the Chief Executive Medicare may pay to the general practitioner, specialist or consultant physician by whom, or on whose behalf, the professional service was rendered an amount equal to the amount of the medicare benefit.

the request under subsection (2) or (2A), by the person to whom the medicare benefit concerned is payable, to give or send a cheque for the amount of the medicare benefit is taken to have been withdrawn; and

the person may not subsequently make a request under subsection (2) or (2A) in respect of that medicare benefit.

the first-mentioned eligible person assigns his or her right to the payment of the medicare benefit to the practitioner; and

the practitioner accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the first-mentioned eligible person.

a medicare benefit would, apart from this section and section 19AD, be payable to an eligible person in respect of a professional service rendered to the eligible person or another person while hospital treatment or hospital-substitute treatment is provided to the eligible person or other person; and

the eligible person has entered into a complying health insurance policy with a private health insurer under which he or she is covered (wholly or partly) for liability to pay fees and charges in respect of that professional service;

the eligible person and the insurer, an approved billing agent or another person may enter into an agreement, in accordance with the approved form, under which the eligible person assigns his or her right to the payment of the medicare benefit to the insurer, approved billing agent or other person.

a pathology service is rendered by or on behalf of an approved pathology practitioner; and

the approved pathology practitioner is acting, in relation to the rendering of the pathology service, on behalf of another person;

the pathology service shall be deemed, for the purposes of this section, not to have been rendered on behalf of that other person.

section 8 (interests to which the Act does not apply);

(b) security interest);section 12 (meaning of

Chapter 9 (transitional provisions).

meet any requirements specified in the regulations; and

be accompanied by the fee (if any) specified in the regulations.

Any fee specified in the regulations must be reasonably related to the expenses incurred or to be incurred by the Commonwealth in relation to the application and must not be such as to amount to taxation.

make guidelines for the purposes of subsection (3); and

determine conditions for the purposes of subsection (5).

if the Chief Executive Medicare were considering whether to approve the billing agent under section 20AB, the guidelines under subsection 20AB(6) would prevent the approval; or

the billing agent has contravened the conditions to which the approval is subject under subsection 20AB(5).

include the Chief Executive Medicare’s reasons for considering the revocation; and

(b) invite the billing agent to make written submissions to the Chief Executive Medicare within the period of 28 days (the submission period) after being given the notice.

decides not to approve a person or body as a billing agent under section 20AB; or

revokes the approval of a person or body as a billing agent under section 20AC;

the person or body may apply to the Chief Executive Medicare for reconsideration by the Chief Executive Medicare of the decision.

affirm the decision; or

approve the person or body as a billing agent.

An approval under paragraph (b) is taken, for the purposes of this Act, to be an approval under section 20AB.

affirm the revocation; or

reinstate the approval of the person or body.

A reinstatement under paragraph (b) has effect as if the approval had never been revoked.

in respect of a professional service other than a professional service referred to in paragraph (b)—shall be made in accordance with the approved form and lodged with the Chief Executive Medicare, or (in such circumstances and subject to such conditions as are prescribed by the regulations) sent to the Chief Executive Medicare in such manner as the Chief Executive Medicare determines; or

in respect of a professional service rendered before such date (if any) as is prescribed—shall be made in accordance with the approved form and lodged with the Chief Executive Medicare, or (in such circumstances and subject to such conditions as are prescribed by the regulations) sent to the Chief Executive Medicare in such manner as the Chief Executive Medicare determines, within the period of 2 years, or such further period as is allowed in accordance with subsection (3A), after the rendering of the service.

be made in accordance with the approved form; and

be lodged with the Chief Executive Medicare, or (in such circumstances and subject to such conditions as are prescribed by the regulations) sent to the Chief Executive Medicare in such manner as the Chief Executive Medicare determines, within the following period after the rendering of the professional service, or such further period as is allowed in accordance with subsection (3A):

if the claim is for a medicare benefit the right to the payment of which has been assigned under subsection 20A(2A)—2 years;

otherwise—1 year.

in the case of an agreement under subsection 20A(1) that was signed by each party in the presence of the other—the assignor retained in his or her possession after the agreement was so signed a copy of the agreement; or

in the case of an agreement under subsection 20A(1) that was signed by the assignor in circumstances other than those referred to in paragraph (c)—the assignor retained in his or her possession after so signing a copy of the document so signed.

a person refers a patient, in writing, to a consultant physician or a specialist; and

the physician or specialist receives the referral; and

the physician or specialist renders a specialist medical service to the patient as a consequence of the referral;

the physician or specialist must:

retain the referral for the period of 2 years beginning on the day on which the service was rendered to the patient; and

(e) produce the referral, if asked to do so by the Chief Executive Medicare, to a medical practitioner who is a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973) within 7 days after receiving the request.

a consultant physician or specialist renders a specialist medical service to a patient; and

either:

the service was rendered to the patient in an emergency situation without a referral; or

the service was rendered as a consequence of a referral that was recorded on a hospital record and not given to the physician or specialist to retain on his or her records;

the Chief Executive Medicare may request the physician or specialist to produce such information as is in his or her possession or control relating to whether the patient was so treated:

(c) to a medical practitioner who is a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973); and

within 7 days after receiving the Chief Executive Medicare’s request.

the retention of the referral or information as so recorded is taken to be a retention of the referral or information; and

the production of the referral or other information as so recorded is taken to be a production of the referral or information.

a person renders a health service that is taken to be a professional service because of a determination in force under subsection 3C(1); and

the service is taken, in accordance with the determination, to be specified in an item of the general medical services table; and

the item mentions being referred by a medical practitioner, a general practitioner, a specialist or a consultant physician; and

a claim is made for an amount to be paid under this Act in respect of the service;

the person must retain the referral for the period of 2 years beginning on the day the service is rendered.

the person is required to keep a referral under subsection (1); and

the person is given a notice under subsection (2); and

the person fails to comply with the notice within the period specified in the notice.