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COMMONWEALTHAct
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s 19

Medicare benefit not payable in respect of certain professional services

In force
Volume 1Parts I to VAA (sections 1 to 106ZR)
Part IIMedicare benefits

19 Medicare benefit not payable in respect of certain professional services

(1)

A medicare benefit is not payable in respect of a professional service that is a medical examination for the purposes of:

(a)

life insurance;

(b)

superannuation or provident account schemes; or

(c)

admission to membership of a friendly society.

(2)

Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a professional service that has been rendered by, or on behalf of, or under an arrangement with:

(a)

the Commonwealth;

(b)

a State;

(c)

a local governing body; or

(d)

an authority established by a law of the Commonwealth, a law of a State or a law of an internal Territory.

(3)

Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a professional service rendered to a person if:

(a)

the medical expenses in respect of that professional service were incurred by the employer of that person; or

(b)

the person to whom that professional service was rendered was employed in an industrial undertaking and that professional service was rendered to him or her for purposes connected with the operation of that undertaking.

(4)

A medicare benefit is not payable in respect of a professional service rendered in the course of the carrying out of a mass immunization.

(5)

Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a health screening service, that is to say, a professional service that is a medical examination or test that is not reasonably required for the management of the medical condition of the patient.

(6)

A medicare benefit is not payable in respect of a professional service unless the person by or on behalf of whom the professional service was rendered, or a person authorised by that person, has recorded such particulars as are prescribed in relation to professional services generally or in relation to a class of professional services in which that professional service is included in the following manner:

(a)

unless paragraph (b) applies—on the account, or on the receipt, for fees in respect of the service;

(b)

if regulations made for the purposes of this paragraph specify a manner—in that manner.

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