Document ID: chunk:federal_register_of_legislation:F2024C00800:front:0:p39
Version: federal_register_of_legislation:F2024C00800
Segment Type: other
Provision Reference: 
Character Range: 104197–107201

of services
    4.2.1 Unless otherwise indicated in these Principles, an entitled person may be provided with only those services included in the Medicare Benefits Schedule.

4.2.2 The services referred to in paragraph 4.2.1 may be provided only by:

(a) a general practitioner; or

(b) a medical specialist.

       4.2.3 (1) An entitled person may be provided with services that are not made available under the Medicare Benefits Schedule ("unlisted services").

        (2) Unlisted services are not to be provided to an entitled person if the Commission is satisfied that they are:

         (a) a mere improvement on existing Medicare Benefits Schedule listed services; or

          (b) experimental and have not been demonstrated to be effective or safe by extensive clinical trials.

    4.2.4 Subject to paragraph 4.2.3(2), unlisted services are to be provided to an entitled person under paragraph 4.2.3(1) if the Commission is satisfied that the services will provide a substantial benefit to the health of the entitled person.

    Note 1: the prior approval of the Commission is required before unlisted services may be provided (Paragraph 3.2.1 (b)).

    Note 2: the availability of funds and the need to reasonably control expenditure are factors to be considered in granting prior approval (Subparagraphs 3.2.2 (c) and (d)).

4.2.5 The services referred to in paragraph 4.2.3 may be provided only by:

(a) a general practitioner; or

(b) a medical specialist.
              4.2.6 Optical Coherence Tomography

    4.2.7 The Commission may accept financial responsibility for Optical Coherence Tomography (OCT) provided to an entitled person by an Ophthalmologist for the assessment or management of retinal disease.

    Note: While OCT remains an unlisted treatment it is subject to all the requirements for an unlisted treatment except prior approval.

4.3 Financial responsibility
4.3.1 Subject to paragraph 3.5.1, and unless otherwise indicated in these Principles, the Commission will accept financial responsibility for treatment costs where a general practitioner or specialist provides or arranges for treatment of:

         (a) an entitled person who has been issued with a Gold Card; or

         (b) an entitled person who has been issued with a White Card for any service injury or service disease; or

(c) a person who has been issued with a written authorisation on behalf of the Commission;

         Note: Principle 3.5.1 also deals with financial liability for medical practitioner fees.

4.3.2 In relation to any occasion of service to an entitled person under these Principles, a general practitioner or specialist shall bill only:

(a) the Department; or

      (b) the Commission; or

 (c) the Human Services Department,

and that bill shall be for full settlement of the account for the service provided to the entitled person.

4.3.3 Any billing method described in paragraph 4.3.2 may be used on each occasion of service.

4.3.4 Subject to paragraph 4.7.3, the