Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020

Contents

1. Name#

This instrument is the Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020.

3.Authority#

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4.Definitions#

(1) In this instrument:

Act means the Health Insurance Act 1973.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

Note: The following terms are defined in subsection 3(1) of the Act:

 clinically relevant service;

 general medical services table;

 item;

 professional service.

(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

5.Treatment of relevant services#

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a) it were both a professional service and a medical service; and

(b) there were an item in the general medical services table that:

i. related to the service; and

ii. specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

6. Application of provisions of the general medical services table#

(1)Clause 5.8.1 of the general medical services table shall have effect as if item 18365 of this Determination was specified in the clause.

(2)Clause 5.8.2 of the general medical services table shall have effect as if item 18365 of this Determination was specified in subclause 5.8.2(2) and 5.8.2(3).

7. Indexation #

(1)At the start of 1 July 2026 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department of Health, Disability and Ageing’s MBS Online website (www.mbsonline.gov.au).

(2)The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.

(3)An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

Schedule 1 · relevant services

Group T11—Botulinum toxin
Column 1Item	Column 2Description	Column 3Fee ($)
18365	Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin-Haemagglutinin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of moderate to severe spasticity of the upper limb following an acute event, if:(a) the patient is at least 18 years of age; and(b) treatment is provided as:(i) second line therapy when standard treatment for the condition has failed; or(ii) an adjunct to physical therapy; and(c) the patient does not have established severe contracture in the limb that is to be treated; and(d) the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve, with a maximum of 4 sets of injections for the patient on any one day (with a maximum of 2 sets of injections for each upper limb), including all injections per set; and(e) for a patient who has received treatment on 2 previous separate occasions—the patient has responded to the treatment	129.90

Sourced from the Federal Register of Legislation at legislation.gov.au, © Commonwealth of Australia, licensed under CC BY 4.0. Compilations may have been reformatted.

Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020

1. Name#

3.Authority#

4.Definitions#

5.Treatment of relevant services#

6. Application of provisions of the general medical services table#

7. Indexation #

Schedule 1 · relevant services

Connections

History · 1 version

1. Name#

3.Authority#

4.Definitions#

5.Treatment of relevant services#

6. Application of provisions of the general medical services table#

7. Indexation #

Schedule 1 · relevant services

Key facts

1. Name#

3.Authority#

4.Definitions#

5.Treatment of relevant services#

6. Application of provisions of the general medical services table#

7. Indexation#

Schedule 1 · relevant services

Connections

History · 1 version

1. Name#

3.Authority#

4.Definitions#

5.Treatment of relevant services#

6. Application of provisions of the general medical services table#

7. Indexation#

Schedule 1 · relevant services

Key facts

7. Indexation #

7. Indexation #