Health Insurance (Assignment of Medicare Benefits - Categories of Professional Services) Determination 2026

Contents

1Name#

This instrument is the Health Insurance (Assignment of Medicare Benefits - Categories of Professional Services) Determination 2026.

2Commencement#

These Regulations shall come into force on 17th March 1987 and shall have effect as from 25th November 1982.

(1)Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information
Column 1	Column 2	Column 3
Provisions	Commencement	Date/Details
The whole of this instrument	At the same time as Schedule 3, Part 2 of the Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025.	1 July 2026

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3Authority#

This instrument is made under section 20AAB of the Health Insurance Act 1973.

4Schedules#

Note: A number of expressions used in this instrument are defined in subsection 3(1) of the Act, including the following:

(a) item;

(b) professional service;

(1)In this instrument:

Act means the Health Insurance Act 1973.

Group means a group of the table.

Subgroup means a subgroup of the table.

(2)In this instrument:

(a)a reference to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service; and

(b)a reference to a professional service includes a reference to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if it were a professional service.

5Categories of professional services etc#

For the purposes of section 20AAB of the Act:

(a)column 1 of the table in Schedule 1 to this instrument specifies categories of professional services; and

(b)for a category of professional service specified in column 1 of a table item, column 2 of that table item specifies the professional services that are in that category.

Schedule 1 · Categories of professional services and specified professional services

1 Categories of professional services and specified professional services

Item	Column 1Category	Column 2Professional services
1	Allied Health	Professional services covered by each of the following items:(a) items 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355 and 81360;(b) an item in Group M6, M7, M8, M9, M10, M15 or M16;(c) an item in Subgroup 2 of Group M3;(d) an item in the following Subgroups of Group M18:(i) Subgroups 1 to 4;(ii) Subgroups 6 to 9;(iii) Subgroups 11 to 22;(iv) Subgroups 25 and 26.
2	Any Provider - Planning	Professional services covered by each of the following items:(a) items 15902, 15904, 15906, 15908, 15910, 15912, 15914, 15916, 15918, 15920, 15922, 15924, 15926 and 15928;(b) an item in Subgroup 15 of Group T2.
3	Any Provider - Procedure	Professional services covered by each of the following items:(a) items 13870, 13873, 13876, 13881, 13882, 13885, 13888, 15930, 15932, 15934, 15936, 15938, 15940, 15942, 15944, 15946, 15948, 16400, 16401, 16404, 16406, 16500, 16501, 16502, 16505, 16508, 16509, 16511, 16512, 16514, 16515, 16518, 16519, 16520, 16522, 16527, 16528, 16530, 16531, 16533, 16534, 16564, 16567, 16570, 16571, 16573, 16600, 16603, 16606, 16609, 16612, 16615, 16618, 16621, 16624, 16627, 17615, 17645, 17680, 53700, 53702, 53704, 91850, 91853, 91855 and 91858;(b) an item in Group D1, M33, O2, O3, O4, O6, T3, T7, T8, T9 or T11;(c) an item in the following Subgroups:(i) Subgroup 4 of Group M14;(ii) Subgroups 1 to 6, 8 to 9 and 11 to 14 of Group T1;(iii) Subgroups 10, 12 and 13 of Group T2.
4	GP - Care Planning and Health Assessments	Professional services covered by each of the following items:(a) items 139, 272, 276, 281, 282, 735, 739, 743, 747, 750, 758, 930, 933, 935, 937, 943, 945, 90264, 90265, 92142, 92170, 92171, 92176 and 92177;(b) an item in Group A14;(c) an item in the following Subgroups:(i) Subgroups 5 and 6 of Group A7;(ii) Subgroup 1 of Group A15;(iii) Subgroup 1 of Group A20;(iv) Subgroup 1 of Group A36;(v) Subgroups 11, 13, 19, and 21 of Group A40.
5	GP - Long	Professional services covered by each of the following items:(a) items 36, 37, 44, 47, 54, 57, 60, 65, 123, 124, 151, 165, 189, 191, 197, 199, 203, 206, 283, 285, 286, 287, 301, 303, 309, 311, 313, 315, 376, 377, 378, 379, 380, 381, 382, 390, 391, 741, 745, 766, 769, 788, 789, 2197, 2198, 2200, 2487, 2488, 2489, 2490, 2491, 2492, 2493, 2494, 2495, 5040, 5043, 5044, 5049, 5060, 5063, 5067, 5071, 5076, 5077, 5207, 5208, 5209, 5227, 5228, 5261, 5262, 5265, 5267, 90043, 90051, 90054, 90095, 90096, 90098, 90202, 90212, 90215, 91801, 91802, 91804, 91805, 91807, 91808, 91900, 91903, 91906, 91910, 91913, 91916, 91920, 91923, 91926, 92721, 92722, 92723, 92724, 92725, 92726, 92737, 92738, 92739, 92740, 92741 and 92742;(b) an item in Group A27;(c) an item in the following Subgroups:(i) Subgroup 11 of Group A7;(ii) Subgroup 2 of Group A20;(iii) Subgroup 4 of Group A36;(iv) Subgroups 3, 10, 15, 16, 27 and 28 of Group A40.
6	GP - Other	Professional services covered by each of the following items:(a) items 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035, 5036 and 5042;(b) an item in Groups A5, A6, A11 or A17;(c) an item in the following Subgroups:(i) Subgroups 3, 4 and 7 of Group A7;(ii) Subgroup 29 of Group A40.
7	GP - Short	Professional services covered by items 3, 4, 52, 58, 179, 181, 733, 761, 772, 5000, 5003, 5010, 5200, 5220, 5260, 90020, 90092, 90183, 91790, 91792, 91794, 91890, 91892, 92715, 92716, 92717, 92731, 92732 and 92733.
8	GP - Standard	Professional services covered by items 23, 24, 53, 59, 185, 187, 193, 195, 373, 374, 375, 737, 763, 776, 2484, 2485, 2486, 5020, 5023, 5028, 5203, 5223, 5263, 90035, 90093, 90188, 91800, 91803, 91806, 91891, 91893, 92718, 92719, 92720, 92734, 92735 and 92736.
9	Midwife - Long	Professional services covered by items 82100, 82102, 82103, 82104, 82110, 82115, 82130, 82135, 82140, 91212, 91214, 91215, 91219, 91221 and 91222.
10	Midwife - Other	Professional services covered by items 82116, 82118, 82120, 82123, 82125 and 82127.
11	Midwife - Short	Professional services covered by items 82105, 91211 and 91218.
12	Nurse Practitioner - Long	Professional services covered by items 82210, 82215, 82216, 82252, 82253, 82254, 82255, 82256, 82257, 91179, 91180, 91190, 91191 and 91206.
13	Nurse Practitioner - Other	Professional services covered by items 82226, 82227 and 82228.
14	Nurse Practitioner - Short	Professional services covered by items 82200, 91192 and 91193.
15	Nurse Practitioner - Standard	Professional services covered by items 82205, 82250, 82251, 91178 and 91189.
16	Optometry	Professional services covered by an item in Group A10.
17	Practice Nurse or Aboriginal and Torres Strait Islander Health Practitioner/Worker	Professional services covered by each of the following items:(a) items 10950 and 81300;(b) an item in Group M12;(c) an item in Subgroups 23 and 24 of Group M18.
18	Simple Pathology Services	Professional services covered by an item in Group P9.
19	Specialist - Care Planning and Health Assessments	Professional services covered by each of the following items:(a) items 132, 133, 135, 137, 289, 291, 293, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864, 866, 871, 872, 880, 946, 948, 959, 961, 962, 964, 6023, 6024, 6057, 6058, 16590, 16591, 90266, 90267, 92140, 92141, 92172, 92173, 92422, 92423, 92434, 92435, 92436, 92441, 92442, 92443, 92444, 92762, 92763, 92767 and 92768;(b) an item in Group A28 or A33;(c) an item in the following Subgroups:(i) Subgroups 2 and 4 of Group A24;(ii) Subgroup 3 of Group A31;(iii) Subgroup 3 of Group A32;(iv) Subgroup 2 of Group A36;(v) Subgroups 23, 31 and 32 of Group A40.
20	Specialist - Long	Professional services covered by each of the following items:(a) items 125, 126, 127, 129, 296, 297, 299, 304, 306, 308, 314, 316, 318, 319, 324, 326, 328, 334, 336, 338, 342, 344, 345, 346, 347, 349, 412, 413, 416, 417, 5041, 6013, 6015, 13899, 16407, 16408, 17620, 17625, 17650, 17655, 22002, 22007, 22008, 22012, 22014, 22015, 22020, 22025, 22031, 22032, 22036, 22041, 22051, 22052, 22053, 22054, 22055, 22060, 22065, 22075, 91829, 91830, 91831, 91839, 91851, 91852, 91856, 91857, 91870, 91871, 91872, 91873, 91876, 91877, 91878, 91881, 91884, 92437, 92446, 92447, 92455, 92456, 92457, 92480, 92481, 92482, 92483, 92515, 92516, 92613 and 92614;(b) an item in the following Subgroups:(i) Subgroup 2 of Group A31;(ii) Subgroups 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 25 and 26 of Group T10.
21	Specialist - Other	Professional services covered by items 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019 and 5039.
22	Specialist - Short	Professional services covered by items 119, 120, 131, 300, 310, 320, 330, 341, 410, 414, 2814, 2840, 3014, 3028, 91826, 91827, 91836, 91837, 91868, 91874, 91879, 91882, 92478, 92513, 92521, 92753, 92754, 92757, 92758, 92761 and 92766.
23	Specialist - Standard	Professional services covered by each of the following items:(a) items 104, 105, 106, 107, 108, 109, 110, 111, 115, 116, 117, 122, 128, 294, 302, 312, 322, 332, 343, 411, 415, 2801, 2806, 2824, 2832, 3005, 3010, 3018, 3023, 6007, 6009, 6011, 6018, 6019, 6051, 6052, 17610, 17615, 17640, 17645, 22042, 53706, 91824, 91825, 91828, 91838, 91869, 91875, 91880, 91883, 92440, 92445, 92479, 92514, 92522, 92610, 92611, 92612, 92618, 92748, 92749, 92750, 92751, 92752, 92755, 92756, 92759, 92760, 92764 and 92765;(b) an item in Group A9, A12, A37, C1, O1, O5, O7, O8 or O9;(c) an item in the following Subgroups:(i) Subgroup 2 of Group A32;(ii) Subgroups 4, 7 and 37 of Group A40.

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Health Insurance (Assignment of Medicare Benefits - Categories of Professional Services) Determination 2026

1Name#

2Commencement#

3Authority#

4Schedules#

5Categories of professional services etc#

Schedule 1 · Categories of professional services and specified professional services

Connections

Defined terms · 3

History · 1 version

1Name#

2Commencement#

3Authority#

4Schedules#

5Categories of professional services etc#

Schedule 1 · Categories of professional services and specified professional services

Key facts