Health Insurance (1994-1995 Pathology Services Table) Regulations (Amendment) (Cth)
__________________
I, The Governor-General of the Commonwealth of Australia, acting with the advice of the
Federal Executive Council, make the following Regulations under the
Dated 25 October 1994.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
CARMEN LAWRENCE
Minister for Human Services and Health
____________
1.1 These Regulations commence on 1 November 1994.
2.1 The Health Insurance (1994-1995 Pathology Services Table) Regulations are amended as set out in these Regulations.
3.1 Paragraph 4 (1) (a):
Omit “specified”, substitute “described”.
3.2 Paragraph 4 (2) (d):
After “gold”, insert “, sulfasalazine”.
3.3 Paragraph 4 (3) (a):
Omit “66217”, substitute “66221”.
3.4 Rule 6:
Omit subrules 6 (1) and (2), substitute:
(1) In this rule:
(a) tests of the kind described in item 66235; or
(b) tests of the kind described in item 66405; or
(c) tests of the kind described in item 69229.
(2) This rule applies in respect of a designated pathology service where:
(a) an approved pathology practitioner (‘practitioner A’) in an approved pathology authority:
(i) has been requested to render the designated pathology service; and
(ii) is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render 1 or more (but not all) of the tests included in the service; and
(iii) requests an approved pathology practitioner (‘practitioner B’) in another approved pathology authority to render the test or tests that practitioner A is unable to render; and
(iv) renders each test included in the service, other than the test or tests in respect of which the request mentioned in subparagraph (iii) is made; and
(b) the tests mentioned in subparagraph (a) (iv) that practitioner A renders are not tests constituting a service described in item 66239, 66415 or 69239.
(2A) Where this rule applies in respect of a designated pathology service:
(a) item 66235, 66237, 66405, 66407, 66409, 66411, 66413, 69229, 69231, 69233, 69235 or 69237 (as the case requires) applies in respect of the test or tests rendered by practitioner A; and
(b) where practitioner B renders a service under a request referred to in subparagraph (2) (a) (iii)—subject to subrule (2B), the amount specified in item 66241, 66417 or 69241 (as the case requires) is payable for each test that the service comprises.
(2B) For the purposes of paragraph (2A) (b), the maximum number of tests to which item 66241, 66417 or 69241 applies is:
(a) in the case of item 66241:
3 -
X ; or
(b) in the case of item 66417 or 69241:
6 -
X ;
where
3.5 After rule 6, insert:
Except as stated in rule 6, the amount specified in an item is payable only to one approved pathology practitioner in respect of a single patient episode.”.
3.6 New rules 7A and 7B:
After rule 7, insert:
The amount specified in item 66317 is not payable in respect of a pathology service described in the item unless at least one of the following paragraphs applies:
(a) if the HDL cholesterol or apolipoprotein B/A1 ratio of the patient is requested to be determined because the patient has a serum cholesterol level >5.5 mmol/1—the determination is performed on the sample that the serum cholesterol level determination for the patient was performed;
(b) if the HDL cholesterol or apolipoprotein B/A1 ratio of the patient is requested to be determined because the patient has a fasting serum triglyceride level >2.0 mmol/1—the determination is performed on the sample that the serum triglyceride level determination for the patient was performed;
(c) the pathologist who renders the service has a written statement from the medical practitioner who requested the service that the patient is on a lipid lowering drug.
(1) For the purposes of item 66329:
(2) Except where paragraph (a) of item 66329 is satisfied, the amount specified in the item is not payable in respect of a pathology service described in the item unless the pathologist who renders the service has a written statement from the medical practitioner who requested the service that satisfies subrule (3).
(3) The written statement from the medical practitioner must indicate:
(a) that the tests are required for a particular purpose, being a purpose specified in paragraph (b) of item 66329; or
(b) that the medical practitioner who requested the tests suspects the patient has pituitary dysfunction; or
(c) that the patient is on drugs that interfere with thyroid hormone metabolism or function.”.
3.7 Subrule 11 (4):
Omit “P9”, substitute “P8”.
3.8 Rule 11:
Add at the end:
(9) The amount specified in item 73921 is payable only once in respect of a single patient episode.”.
3.9 Part 2 of the Schedule is amended in accordance with the following table:
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3.10 Item 65037:
Omit “and” (first occurring).
3.11 Items 66217, 66219, 66291 and 66371:
Omit the items.
3.12 New item 66221:
After item 66215, insert:
“66221 | Test for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces) by:
each test, to a maximum of 3 tests taken on separate days in a 28 day period | 8.80”. |
3.13 Items 66235, 66237, 66405, 66407, 66409, 66411, 66413, 69229, 69231, 69233, 69235 and 69237:
Add at the end:
“(Item is subject to rule 6)”. |
3.14 Item 66241:
Omit the item, substitute:
“66241 | Tests described in item 66235, if rendered under a request referred to in subparagraph (2) (a) (iii) of rule 6 (Item is subject to rule 6) | 8.20”. |
3.15 Item 66317:
Omit the item, substitute:
“66317 | Quantitation of HDL cholesterol or apolipoprotein B/A1 ratio in a patient who: (a) has a serum cholesterol level >5.5 mmol/1; or
each episode to a maximum of 4 episodes in a 12 month period (Item is subject to rule 7A) | 12.35”. |
3.16 New items 66327 and 66329:
After item 66325, insert:
“66327 | TSH—quantitation, requested as a preliminary test to thyroid function testing | 31.55 |
66329 | Thyroid function tests (comprising the service described in item 66327 and 1 or more of the following tests—estimation of free thyroxine index, free thyroxine, free T3, total T3, thyroxine binding globulin) in respect of a patient, if at least one of the following conditions is satisfied: (a) the patient has an abnormal level of TSH; | 41.00”. |
| ||
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3.17 Item 66417:
Omit the item, substitute:
“66417 | Tests described in item 66405, if rendered under a request referred to in subparagraph (2) (a) (iii) of rule 6 (Item is subject to rule 6) | 11.05 |
“66419 | Oral glucose test that includes the following: (a) administration of glucose; (b) at least 3 estimations of blood glucose;
| 17.70”. |
3.18 Item 69229:
Omit “Schedule”, substitute “Schedule—1 test”.
3.19 Item 69241:
Omit the item, substitute:
“69241 | Tests described in item 69229, if rendered under a request referred to in subparagraph (2) (a) (iii) of rule 6 (Item is subject to rule 6) | 7.40”. |
3.20 Item 73921:
Add at the end:
“(Item is subject to subrule 11 (9))”. |
3.21 Part 3, Division B:
After “Blood—culture”, insert:
“Blood—faecal occult FOB 66221”.
3.22 Part 3, Division B:
After “Electrophoresis, to demonstrate—lactate dehydrogenase isoenzymes”, insert:
“Electrophoresis, to demonstrate—lipoprotein subclasses LEPG 66250”.
3.23 Part 3, Division B (“Electrophoresis, to demonstrate—protein classes, or paraprotein”):
Omit “66249, 66250”, substitute “66249”.
3.24 Part 3, Division B, new entry:
After “Factor XIII deficiency test”, insert:
“Faecal blood FOB 66221”.
3.25 Part 3, Division B (“Glucose—tolerance test”):
Omit “66201”, substitute “66419”.
3.26 Part 3, Division B (“Hormones—thyroid stimulating hormone (where not requested on its own or as part of TFTs)”):
Omit the entry.
3.27 Part 3, Division B (“Thyroid—function tests”):
Omit the entry, substitute:
“Thyroid function tests (including TSH) TFT 66329”.
3.28 Part 3, Division B (“Thyroid-stimulating hormone (where not requested on its own or as part of TFTs)”):
Omit the entry, substitute:
“Thyroid stimulating hormone (if requested on its own, or as a preliminary test to thyroid function testing) TSH 66327
Thyroid stimulating hormone (if requested with other hormones referred to in item 66405)) TSH 66405”.
3.29 Part 3, Division B (“TSH (where not requested on its own or as part of a thyroid function test)”):
Omit the entry.
____________________________________________________________
1. Notified in the
Commonwealth of Australia Gazette on 31 October 1994.
2. Statutory Rules 1994 No. 233.
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