Document ID: chunk:federal_register_of_legislation:F2024C00800:front:0:p41
Version: federal_register_of_legislation:F2024C00800
Segment Type: other
Provision Reference: 
Character Range: 109575–112508

an entitled person to a medical specialist for diagnostic imaging or pathology services not requiring admission and the medical specialist direct bills the Human Services Department at 100 per cent or less of the fee set out in the Medicare Benefits Schedule as full settlement of the account for the service rendered.

4.8 Other matters
4.8.1 The Commission will not accept financial responsibility for the cost of:

         (a) elective surgery undertaken without prior approval with the exception of elective surgery in a public hospital, minor procedures carried out in a general practitioner's or specialist's rooms where the only charge is equivalent to the charge that would be applicable under the Medicare Benefits Schedule for that procedure; or

(b) examination for a medical certificate for life assurance purposes; or

(c) examination for a medical certificate for membership of a friendly society; or

(d) examination for employment purposes; or

(e) multi‑phasic screening; or

(f) services where the cost is otherwise recoverable wholly or partly, by way of a legal claim; or

         (g) services that have been paid for, wholly or partly, by the Human Services Department, as a medicare benefit, or by a health insurance fund; or

         (ga) diabetes educator services under this Part that may be provided under Part 7 (Treatment Generally From Other Health Providers).

PART 5 — DENTAL TREATMENT

5.1 Providers of services
5.1.1 The Commission may accept financial responsibility for dental treatment provided to an entitled person by a dental prosthetist, dentist or dental specialist where the treatment is provided in accordance with these Principles and in accordance with the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects a dental prosthetist, dentist or dental specialist, as the case may be)).

5.1.1A For paragraph 5.1.1, dental treatment provided by a dentist or dental specialist includes dental treatment provided by a dental hygienist, dental therapist or oral health therapist on behalf of the dentist or dental specialist, as the case may be.

5.1.2 The Commission will accept financial responsibility for dental treatment provided to an entitled person in a Tier 1 Hospital or Contracted Day Procedure Centre without the need for prior approval.

    Note: the Notes for Allied Health Providers, the "Fee Schedule of Dental Services for Dentists and Dental Specialists" and the "Fee Schedule of Dental Services for Dental Prosthetists", as incorporated‑by‑reference into the Principles, could be relevant to dental treatment provided to an entitled person in a hospital.

5.1.2A Except in an emergency, the Commission's prior approval is required before dental treatment is provided to an entitled person in a hospital other than a Tier 1 Hospital or on premises other than a Contracted Day Procedure Centre unless the "Fee Schedule