General Medical Services

In the past, general practitioners made a fee-for-service, General Medical Services (GMS) claim when they saw a patient. Since 2003, capitation payments made though primary health organisations (PHOs) to contracted general practices have progressively replaced fee-for-service claiming.

The GMS subsidy remains where a general practice or after-hours treatment provider sees a child or adult who is not enrolled in a PHO or cannot access the practice they are enrolled with during business hours or after hours (casual patient). Much of this GMS service provision is the same as is provided to enrolled patients, the only difference being that the service is provided to casual or non-enrolled patients.

The General Medical Services subsidy

The GMS subsidy is only available to a health practitioner (such as a general practitioner or nurse) where they provide a consultation to someone who is not enrolled in that practice and who is a child, or an adult who has a Community Services Card (CSC) or a High Use Health Card (HUHC). 

The subsidy is not available if the health practitioner sees an adult who does not have a CSC or HUHC. These patients may be charged the full fee by the practice.

GMS subsidies are paid to the general practice at a standard rate regardless of the type or the timing of the service (from July 2015):

Patient GST exclusive
A child under 6 years of age $31.11
A child or young person aged 6 to 17 years who is the dependent of a holder of a Community Services Card or High Use Health Card $17.78
A child or young person aged 6 to 17 years who is not the dependent of a holder of a Community Services Card or High Use Health Card $13.33
A person aged 18 years or over who holds a Community Services Card or High Use Health Card $13.33

A health practitioner who treats a patient who is ineligible to be enrolled in a PHO (such as a visitor from overseas) cannot claim GMS subsidy for that treatment.

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