Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) (Cth)

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Statutory Rules 1996

No. 54 1

__________________

Health Insurance (1995–96 Pathology Services Table) Regulations 2(Amendment)

I, The Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 8 May 1996.

 WILLIAM DEANE

 Governor-General

By His Excellency’s Command,

MICHAEL RICHARD LEWIS WOOLDRIDGE

Minister for Health and Family Services

____________

1.   Commencement

1.1   These Regulations commence on 1 July 1996.

2.   Amendment

2.1   The Health Insurance (1995–96 Pathology Services Table) Regulations are amended as set out in these Regulations.

3.   Schedule (Table of pathology services)

3.1   Subrule 1 (definition of “patient episode”)

Omit paragraph (a), substitute:

  • “(a)

    a pathology service or pathology services (other than a pathology service to which paragraph 1 (1) (b) refers) provided for a single patient whose need for the service or services was determined under subsection 16A of the Act:

    • (i)

      on the same day; or

    • (ii)

      if more than 1 test is performed on the 1 specimen within 14 days—on the same or different days;

 whether the services:

  • (iii)

    are requested by 1 or more practitioners; or

  • (iv)

    are described in a single item or in more than 1 item; or

  • (v)

    are rendered by 1 approved pathology practitioner or more than 1 pathology practitioner; or

  • (vi)

    are rendered on the same or different days; or”.

3.2   New rule 8A:

After rule 8, insert:

 “8A. (1) A medicare benefit is not payable in respect of more than one of items 69266, 69267, 69268, 69269, 69270, 69271, 69272, 69273, 69274, 69275, 69276, 69277, 69278, 69279 and 69281 in a patient episode.

 “(2) For the purposes of item 69279, ‘currently elevated transaminase level’ means a level of alanine aminotransferase or aspartate aminotransferase above the normal reference range in respect of the particular method of assay used to determine the level, as disclosed by a test carried out within the previous 7 days.”.

3.3    Item 66221:

Omit the item.

3.4  After item 66421, insert in Group P2:

“66422

Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces) by:

(a)

an immunological method; and

  • (b)

    a chemical method (except reagent strip or dip stick);

with a maximum of 3 examinations on specimens collected on separate days in a 28 day period—1 examination by both methods

8.80

66423

2 examinations by both methods described in item 66422 performed on separately collected and identified specimens

17.60

66424

3 examinations by both methods described in item 66422 performed on separately collected and identified specimens

26.40”.

3.5   Items 69203, 69211, 69215, 69221, 69243, 69245, 69247, 69249, 69261, 69263 and 69265:

Omit the items.

3.6   After item 69257, insert in Group P3:

“69262

Detection of Chlamydia by any method in specimens from 1 or more sites

19.85

69264

Examination for Herpes simplex virus of 1 or more types by culture in material obtained directly from a patient, including a service described in items 69223, 69262 or 69282 (if performed)

28.20

69266

Investigation for acute Hepatitis A—Hepatitis A IgM antibody test

(Item is subject to rule 8A)

13.90

69267

Determination of immune status to Hepatitis A—Hepatitis A IgG antibody test

(Item is subject to rule 8A)

13.90

69268

Investigation for acute or resolving Hepatitis B, including:

(a)

Hepatitis B surface antigen test; and

  • (b)

    Hepatitis B core antibody test; and

  • (c)

    Hepatitis B e antibody test (if the Hepatitis B surface antigen test is negative and Hepatitis B core antibody test is positive) (if performed)

(Item is subject to rule 8A)

24.70

69269

Investigation for resolving Hepatitis B if Hepatitis B core antibody test is positive and Hepatitis B surface antigen test is negative, including:

(a)

Hepatitis B surface antigen test; and

(b)

Hepatitis B core antibody test; and

(c)

Hepatitis B surface antibody test

(Item is subject to rule 8A)

34.70

69270

Determination of immune status to Hepatitis B (post exposure)—Hepatitis B core antibody test

(Item is subject to rule 8A)

13.90

69271

Determination of immune status to Hepatitis B (post vaccination)—Hepatitis B surface antibody test

(Item is subject to rule 8A)

13.90

69272

Investigation for chronic Hepatitis B or determination of carriage of Hepatitis B antigen—Hepatitis B surface antigen test

(Item is subject to rule 8A)

13.90

69273

Investigation for chronic Hepatitis B or carriage of Hepatitis B antigen if the Hepatitis B surface antigen test is positive, including:

(a)

Hepatitis B surface antigen test; and

(b)

Hepatitis B e antigen test

(Item is subject to rule 8A)

24.70

69274

Investigation for Hepatitis C—Hepatitis C antibody test

(Item is subject to rule 8A)

13.90

69275

Investigation for acute or chronic Hepatitis D in a patient with a positive Hepatitis B surface antigen test—Hepatitis D antibody test

(Item is subject to rule 8A)

13.90

69276

Determination of immune status to Hepatitis A and Hepatitis B, including:

(a)

Hepatitis A IgG antibody test; and

  • (b)

    Hepatitis B core antibody test or Hepatitis B surface antibody test

(Item is subject to rule 8A)

24.70

69277

Investigation for chronic viral hepatitis,

 including:

(a)

Hepatitis B surface antigen test; and

(b)

Hepatitis C antibody test

(Item is subject to rule 8A)

24.70

69278

Investigation for chronic viral hepatitis if

 Hepatitis B surface antigen test is positive, including:

(a)

Hepatitis C antibody test; and

(b)

Hepatitis B surface antigen test; and

(c)

Hepatitis B e antigen test

(Item is subject to rule 8A)

34.70

69279

Investigation for acute Hepatitis A, Hepatitis B or Hepatitis C in a patient with a currently elevated transaminase level, including:

(a)

Hepatitis A IgM antibody test; and

(b)

Hepatitis C antibody test; and

(c)

Hepatitis B surface antigen test; and

  • (d)

    Hepatitis B core antibody test; and

  • (e)

    Hepatitis B e antibody test (if Hepatitis B surface antigen test is negative and Hepatitis B core antibody test is positive) (if performed)

(Item is subject to rule 8A)

44.70

69281

Syphilis serology and any 1 of items 69273, 69274 or 69277

(Item is subject to rule 8A)

34.70

69282

Microscopy and culture to detect pathogenic micro-organisms, including the detection of Chlamydia by any method from urethra, vagina, cervix or rectum and including (if performed):

(a)

the detection of microbial antigens; or

  • (b)

    pathogen identification and antibiotic susceptibility testing; or

  • (c)

    a service described in item 69201, 69205, 69207, 69223, 69262, 69264 or 73810;

1 or more tests on 1 or more specimens

48.10

69285

Microscopy of faeces for parasites using concentration techniques (including the use of

 appropriate stains) with a maximum of 3 examinations on specimens collected on separate days, including a service (if performed) described in item 69201—1 examination

16.20

69286

2 examinations described in item 69285 performed on separately collected and identified specimens

32.40

69287

3 examinations described in item 69285 performed on separately collected and identified specimens

48.60

69289

Culture of faeces for faecal pathogens, using at least 2 selective or enrichment media and culture in at least 2 different atmospheres including (if performed):

  • (a)

    pathogen identification and antibiotic susceptibility testing; and

  • (b)

    the detection of clostridial toxins or antigens not elsewhere specified in this Table; and

  • (c)

    a service described in item 69201;

with a maximum of 3 examinations performed on separately collected and identified specimens in any 7 day period—1 examination

46.45

69290

2 examinations described in item 69289 performed on separately collected and identified specimens

92.90

69291

3 examinations described in item 69289 performed on separately collected and identified specimens

139.35

69293

Blood culture for pathogenic micro-organisms (other than viruses), including sub-cultures and (if performed):

  • (a)

    identification of any cultured pathogen; and

  • (b)

    necessary antibiotic susceptibility testing;

to a maximum of 3 sets of cultures—1 set of cultures

20.80

69294

2 sets of cultures described in item 69293

41.60

69295

3 sets of cultures described in item 69293

62.40”.

NOTES

1. Notified in the Commonwealth of Australia Gazette on 15 May 1996.

2. Statutory Rules 1995 No. 281 as amended by 1995 No. 301; 1996 No. 10.

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