Commonwealth Consolidated Regulations Commonwealth Consolidated Regulations(1) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services generally:
(a) the name of the patient to whom the service was given;
(b) the date on which the service was given;
(c) the amount charged in respect of the service;
(d) the total amount paid in respect of the service;
(e) any amount outstanding in respect of the service.
(1A) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered by a person who has been determined to be a medical practitioner under subsection 3J (1) of the Act:
(a) the name and the address of the medical practitioner;
(b) the provider number of the medical practitioner.
(1B) For the purposes of subsection 19 (6) of the Act, the particulars prescribed in relation to professional services rendered by a medical practitioner other than a medical practitioner referred to in subregulation (1A) are:
(a) the name and the address of the medical practitioner; and
(b) the provider number of the medical practitioner;
either or both of which may be given.
(1C) For subsection 19 (6) of the Act, either or both of the following particulars are prescribed for professional services provided by a participating midwife or participating nurse practitioner:
(a) the name and address of the participating midwife or participating nurse practitioner;
(b) the provider number of the participating midwife or participating nurse practitioner.
(2) For subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered as part of an episode of hospital treatment:
(a) a description of the professional service and the item number of the item that relates to the professional service, followed by an asterisk; or
(b) a description of the professional service sufficient to identify the item that relates to the professional service, preceded by the word 'patient'.
(2A) For subsection 19 (6) of the Act, if professional services are rendered as part of an episode of hospital-substitute treatment and the person who receives the treatment chooses to receive a benefit from a private health insurer, the following particulars are prescribed for those services:
(a) a description of the professional service and the item number of the item that relates to the professional service, followed by the words 'hospital-substitute treatment'; or
(b) a description of the professional service sufficient to identify the item that relates to the professional service, preceded by the words 'hospital-substitute treatment'.
(3) For the purposes of subsection 19 (6) of the Act, the following particular is prescribed in relation to professional services other than professional services referred to in subregulation (2), namely, a description of the professional service sufficient to identify the item that relates to the service.
(4) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who was referred to that consultant physician or specialist in the manner prescribed in regulation 29 by a referring practitioner:
(a) the name of the referring practitioner;
(b) the address of the place of practice, or the provider number in respect of the place of practice, of the referring practitioner;
(c) the date on which the patient was referred by the referring practitioner to the consultant physician or specialist;
(d) the period of validity of the referral applicable under regulation 31.
(5) For the purposes of subsection 19 (6) of the Act, if a referral is given under subregulation 30 (1) the words, 'referral within ( insert the name of the hospital in which the referral was given )' are prescribed.
(6) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who has declared to the consultant physician or specialist that a referral referring the patient to that consultant physician or specialist has been completed by a referring practitioner, the name of the referring practitioner, and that the referral has not been delivered to the consultant physician or specialist due to the referral having been lost, stolen or destroyed:
(a) the name of the referring practitioner;
(b) the words 'lost referral';
(c) the address of the place of practice, or the provider number in respect of the place of practice, of the referring practitioner (if either of these are known to the consultant physician or specialist).
(7) For the purposes of subsection 19 (6) of the Act, the word 'emergency' is prescribed if:
(a) a referring practitioner; or
(b) a specialist or consultant physician in the practice of his or her speciality;
decides in an emergency that it is necessary in the patient's interests for a professional service to be given as soon as practicable.
(8) For the purposes of subsection 19 (6) of the Act, the following particular is prescribed in relation to professional services to which an item in items 3 to 10929 (inclusive) of the general medical services table relates, namely, where a practitioner or optometrist was in attendance on a person on more than one occasion on the same day and on each occasion rendered such a professional service on that person, the time at which each such attendance on that day commenced.
(8A) For subsection 19 (6) of the Act, subregulation (8B) applies if a participating midwife or participating nurse practitioner:
(a) attends a person more than once on the same day; and
(b) on each occasion provides a professional service to the person.
(8B) The time each attendance starts is prescribed as a particular for the participating midwife or participating nurse practitioner.
(9) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services to which an item in the pathology services table relates:
(a) where the professional service is a pathology service in respect of which the payment of a medicare benefit is not prevented by the operation of subsection 16A (1), (2) or (3) of the Act:
(i) the name and:
(A) where the request referred to in subsection 16A (3) of the Act in respect of which the professional service was rendered was made at the place of practice of the practitioner, participating midwife or participating nurse practitioner who determined that the professional service was necessary -- the provider number in respect of that place of practice of that practitioner, participating midwife or participating nurse practitioner; or
(B) where that request was not made at the place of practice of the practitioner, participating midwife or participating nurse practitioner who determined that the professional service was necessary -- the provider number in respect of any place of practice of that practitioner, participating midwife or participating nurse practitioner; and
(ii) the date on which the practitioner, participating midwife or participating nurse practitioner so determined that the service was necessary;
(b) where the professional service is a pathologist- determinable service that was determined to be necessary by the approved pathology practitioner by whom, or on whose behalf, the service was performed -- the initials 's.d.' or 'p.d.';
(c) where the professional service is a pathology service to which subsection 16A (7) of the Act applies -- if the service was rendered in pursuance of a request of the kind referred to in paragraph 16A (7) (b) of the Act -- the date on which the request referred to in that subparagraph was made and the surname, and the initials of the Christian or given names, of the medical practitioner who determined that the service was necessary or, where at least one other member of the group of practitioners of which he is a member has the same surname and the same initials as the medical practitioner, the surname, and such of the Christian or given names, of the medical practitioner as distinguish him from each of those other members.
(10) For subsection 19 (6) of the Act, if the professional service rendered is the collection of a specimen and is the initiation of a patient episode, there is to be recorded, for that pathology service, the appropriate collection point identification number as follows:
(a) for a collection made at an approved collection centre, the approved pathology collection centre identification number assigned by the Chief Executive Medicare to that collection centre;
(b) for a collection made at a recognised hospital, the recognised hospital collection point identification number assigned by the Chief Executive Medicare to that hospital;
(d) for a collection made at a location not described in paragraph (a) or (b), the collection point identification number 'A01'.
(10A) An identification number mentioned in paragraph (10) (a) (an approved pathology collection centre identification number) is valid only in relation to a collection made at an approved collection centre by the Approved Pathology Authority that is the owner of that collection centre.
(11) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services to which any of items 12500 to 12533 (inclusive), 15000 to 15600 (inclusive) and 16003 to 16015 (inclusive) of the general medical services table or an item in the diagnostic imaging services table relates:
(a) if the professional service is provided by a specialist in diagnostic radiology -- the name and either the address of the place of practice, or the provider number, of that specialist; or
(b) if the professional service is provided by a practitioner other than a specialist in diagnostic radiology -- the name and either the address of the place of practice, or the provider number in respect of the place of practice, of the practitioner who:
(i) is claiming, or receiving, payment of fees in respect of the professional service; or
(ii) is the assignee of the right to the payment of that benefit under an assignment or agreement made in accordance with section 20A of the Act, in relation to the medicare benefit in respect of the professional service, if an assignment of that kind has been made, or an agreement of that kind entered into.
(12) For the purposes of subsection 19 (6) of the Act, the following particulars are prescribed in relation to professional services to which an item in the pathology services table, other than items 73801 to 73811 (inclusive), relates, namely, the name and either the address of the place of practice, or the provider number in respect of the place of practice, of:
(a) the approved pathology practitioner by whom, or on whose behalf, the professional service was rendered;
(b) where the professional service was rendered wholly in an accredited pathology laboratory -- any approved pathology practitioner by whom, or on whose behalf, professional services may be rendered in that accredited pathology laboratory; or
(c) where the professional service, being a professional service in respect of which a request was made:
(i) to an approved pathology practitioner rendering professional services in an accredited pathology laboratory owned and controlled by a single approved pathology authority; or
(ii) to the approved pathology authority owning and controlling that accredited pathology laboratory;
was rendered partly in that accredited pathology laboratory and partly in another accredited pathology laboratory owned and controlled by the same approved pathology authority -- any approved pathology practitioner by whom, or on whose behalf, professional services may be rendered in the first-mentioned accredited pathology laboratory.
(13) For subsection 19 (6) of the Act, the following particulars are prescribed for professional services other than those mentioned in subregulation (13A):
(a) the name of the practitioner, optometrist, participating midwife or participating nurse practitioner who provided the professional service;
(b) a statement that the professional service was provided by that person;
(c) either:
(i) the address of the place of practice where the service was provided; or
(ii) both:
(A) if the service was provided at a place of practice for which that person has been allocated a provider number -- the provider number; and
(B) in any other case -- the provider number allocated to that person for any place where he or she practices.
(13A) Subregulation (13) does not apply to a professional service to which any of the following items relate:
(a) an item in the pathology services table other than items 73801 to 73811 (inclusive);
(b) any of items 12500 to 12533 (inclusive), 15000 to 15600 (inclusive) and 16003 to 16015 (inclusive) of the general medical services table;
(c) an item in the diagnostic imaging services table.
(14) Subject to subregulations (15) and (16), the following particulars are prescribed for the purposes of subsection 19 (6) of the Act in relation to professional services to which an item in the diagnostic imaging services table relates:
(a) the name and either:
(i) the address of the place of practice; or
(ii) the provider number in respect of the place of practice;
of the person who requested that professional service;
(b) the date on which that professional service was requested;
(c) the name and either:
(i) the address of the place of practice; or
(ii) the provider number in respect of the place of practice;
of the practitioner who:
(iii) is claiming, or receiving, payment of fees in respect of that professional service; or
(iv) if an assignment has been made, or an agreement entered into, in accordance with section 20A of the Act, in relation to the medicare benefit in respect of that professional service, is the assignee of the right to the payment of that benefit under that assignment or agreement.
(15) If the person referred to in paragraph (14) (a) is a chiropractor, osteopath, physiotherapist or podiatrist, the reference in subparagraph (14) (a) (ii) to a provider number is a reference to a requester number.
(16) For the purposes of subsection 19 (6) of the Act, if the practitioner referred to in paragraph (14) (c) is not the practitioner who rendered the professional service referred to in subregulation (14), the following additional particulars are prescribed in relation to that professional service, namely the name and either:
(a) the address of the place of practice; or
(b) the provider number in respect of the place of practice;
of the second-mentioned practitioner, unless those particulars and the date on which the professional service was requested are recorded at the place of practice of the first-mentioned practitioner.
(17) For the purposes of subsection 19 (6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered:
(a) by a consultant physician or a specialist in circumstances specified in subsection 16B (6) of the Act; or
(b) within an area that is a remote area for the purposes of Division 2 of Part IIB of the Act in circumstances specified in subsection 16B (7) of the Act; or
(c) as an additional necessary service in circumstances specified in subsection 16B (10) of the Act; or
(d) in circumstances specified in subsection 16B (11) of the Act;
the following particular is prescribed in relation to those services -- the letters 'SD', indicating that the services were self-determined.
(17A) For subsection 19 (6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered in the circumstances mentioned in subsection 16B (10A) of the Act, the letters 'SS' (indicating that the services were substituted for a requested service) are a prescribed particular in relation to those services.
(18) For the purposes of subsection 19 (6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered in circumstances specified in subsection 16B (8) of the Act, the following particular is prescribed in relation to those services -- the word 'emergency'.
(19) For the purposes of subsection 19 (6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered in circumstances specified in subsection 16B (9) of the Act, the following particular is prescribed in relation to those services -- the words 'lost request'.
(20) For subsection 19 (6) of the Act, the following additional particulars are prescribed in relation to professional services to which any of items 23010 to 24136 of the general medical services table relates:
(a) if the service rendered is administration of anaesthesia (other than administration of anaesthesia performed in association with a service to which item 22900 or 22905 applies):
(i) the name of each practitioner who performed a procedure for which the anaesthesia was administered; and
(ii) if item 25025 applies to the service -- when the service time began and ended, and the duration of the service time; and
(b) if the service rendered is perfusion to which item 25050 applies -- when the service time began and ended, and the duration of the service time; and
(c) if the service rendered is assistance in the administration of anaesthesia:
(i) the name of the principal anaesthetist; and
(ii) the name of each practitioner who performed a procedure for which the anaesthesia was administered; and
(iii) if item 25030 applies to the service -- when the service time began and ended, and the duration of the service time.
(21) In subregulation (20):
"service time" has the meaning given by clause 2.43.4 in Part 2 of the general medical services table.
(22) For subsection 19 (6) of the Act, in relation to professional services consisting of:
(a) diagnostic imaging services rendered using a diagnostic imaging procedure carried out using diagnostic imaging equipment ordinarily located at registered diagnostic imaging premises or, when not in use, at a registered base for diagnostic imaging equipment; or
(b) radiation oncology services rendered using radiation oncology equipment ordinarily located at registered radiation oncology premises or, when not in use, at a registered base for radiation oncology equipment;
the location specific practice number for the premises or base is a prescribed particular.
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