Health Insurance (1996-97 Pathology Services Table) Regulations (Amendment) (Cth)

Statutory Rules 1997

No. 54 1

__________________

Health Insurance (1996-97 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 19 March 1997.

 WILLIAM DEANE

 Governor-General

By His Excellency’s Command,

MICHAEL WOOLDRIDGE

Minister for Health and Family Services

____________

1.   Commencement

1.1   These Regulations commence on 20 March 1997.

2.   Amendment

2.1   The Health Insurance (1996-97 Pathology Services Table) Regulations are amended as set out in these Regulations.

3.   Schedule (Table of Pathology Services)

3.1   Schedule, Part 1, paragraph 4 (2) (d):

After “in relation to”, insert “clozaril, ticlopidine hydrochloride,”.

3.2   Schedule, Part 1, paragraph 4 (2) (d):

Omit “gold sulfasalazine”, substitute “gold, sulfasalazine”.

3.3   Schedule, Part 1, subrule 12 (1):

Omit “69279 and 69281”, substitute “69279, 69280, 69281 and 69283”.

3.4   Schedule, Part 1, subrule 12 (2):

Omit “item 69279,”, substitute “items 69279 and 69283,”.

3.5   Schedule, Part 1, subrule 12 (2):

After “carried out”, insert “on a sample taken for the investigation or on a sample taken”.

3.6   After Schedule, Part 1, paragraph 14 (1) (c), insert:

“; and (d) ‘separately identified specimen’ means an individual specimen collected, identified so that it is clearly distinguished from any other specimen, and sent for testing by or on behalf of the treating practitioner responsible for the procedure in which the specimen was taken.”.

3.7   After Schedule, Part 1, subrule 14 (3), insert:

 “14.(4)If more than 1 of the services mentioned in items 72813, 72816, 72817, 72823, 72824, 72825, 72830 and 72836 are performed in a single patient episode, a medicare benefit is payable only for the item performed that has the highest schedule fee.

 “14.(5) If more than 1 histopathological examinations are performed on separate specimens, of different complexity levels, from a single patient episode, a medicare benefit is payable only for the examination that has the highest schedule fee.

“14.(6)In items 72813, 72816, 72817, 72823, 72824, 72825, 72830 and 72836 a reference to a complexity level is a reference to the level given to a specimen type mentioned in Part 4 of this Table.”.

3.8   Schedule, Part 2, item 65005:

Omit subparagraphs (ii) and (iii), substitute:

• “(ii)

  examination of a blood film with alpha-napthyl acetate esterase, chloroacetate esterase, neutrophil alkaline phosphatase, nitroblue tetrazolium, periodic acid Schiff or Sudan Black stains or acid elution stains”.

3.9   Schedule, Part 2, item 65013:

Omit “133.70”, substitute “163.70”.

3.10   After Schedule, Part 2, item 65049, insert in Group P1:

“65052	Examination of a maternal blood film for the presence of fetal red blood cells (Kleihauer test) including any service described in item 65005 (if performed)	10.25
65053	Detection and quantitation of fetal red blood cells in the maternal circulation by detection of red cell surface antigens using flow cytometric methods including any service described in item 65007 or 65052 (if performed)	34.00”.

3.11   Schedule, Part 2, item 66295:

Omit “25.80”, substitute “50.00”.

3.12   Schedule, Part 2, item 66297:

Omit “54.50”, substitute “80.00”.

3.13   Schedule, Part 2, item 66299:

Omit “87.70”, substitute “140.00”.

3.14   After Schedule, Part 2, item 66321, insert:

“66322 Quantitation of glycosylated haemoglobin performed in the management of pre-existing diabetes where the patient is pregnant—each test to a maximum of 6 tests in a 12 month period which includes the whole pregnancy, including a service in item 66319 (if performed) 16.60”.

3.15   Omit Schedule, Part 2, item 66327, substitute:

“66327 TSH quantitation 31.55”.

3.16   Schedule, Part 2, item 66405:

Omit “TSH (where not requested on its own or as part of a thyroid function test),”.

3.17   After Schedule, Part 2, item 66426, insert in Group P2:

“66427	TSH quantitation described in item 66327 and 1 test described in item 66405 (Item is subject to rule 6)	42.55
66428	TSH quantitation described in item 66327 and 2 tests described in item 66405 (Item is subject to rule 6)	53.55
66429	TSH quantitation described in item 66327 and 3 tests described in item 66405 (Item is subject to rule 6)	64.55
66430	TSH quantitation described in item 66327 and 4 tests described in item 66405 (Item is subject to rule 6)	75.55
66431	TSH quantitation described in item 66327 and 5 tests described in item 66405 (Item is subject to rule 6)	86.55
66432	Tests described in items 66327 and 66405, if rendered under a request mentioned in subparagraph 2 (a) (iii) of rule 6—each test to a maximum of 5 tests (Item is subject to rule 6)	11.05”.

3.18   Schedule, Part 2, item 69253:

Omit “69266 to 69281”, substitute “69266 to 69273, 69275 to 69278, 69280 and 69281”.

3.19   Schedule, Part 2, item 69255:

Omit “69266 to 69281”, substitute “69266 to 69273, 69275 to 69278, 69280 and 69281”.

3.20   Schedule, Part 2, item 69257:

Omit “69266 to 69281”, substitute “69266 to 69273, 69275 to 69278, 69280 and 69281”.

3.21   Omit Schedule, Part 2, items 69266 and 69267, substitute:

“69266	Investigation for acute Hepatitis A using:  Hepatitis A IgM antibody test (Item is subject to rule 12)	13.90
69267	Determination of immune status to Hepatitis A using:  Hepatitis A IgG antibody test (Item is subject to rule 12)	13.90”.

3.22   Schedule, Part 2, item 69268:

After “Hepatitis B,”, insert “or testing of close, recent contacts of proven Hepatitis B infection,”.

3.23   Omit Schedule, Part 2, item 69269, substitute:

“69269 Investigation for resolution of Hepatitis B if the Hepatitis B core antibody test is positive and the Hepatitis B surface antigen test is negative, including: (a) Hepatitis B core antibody test; and (b) Hepatitis B surface antigen test; and (c) Hepatitis B surface antibody test (Item is subject to rule 12) 34.70”.

3.24   Omit Schedule, Part 2, items 69270, 69271 and 69272, substitute:

“69270	Determination of immune status to Hepatitis B (post exposure) using:  Hepatitis B core antibody test (Item is subject to rule 12)	13.90
69271	Determination of immune status to Hepatitis B (post vaccination) using:  Hepatitis B surface antibody test (Item is subject to rule 12)	13.90
69272	Investigation for chronic Hepatitis B or determination of carriage of Hepatitis B antigen using:  Hepatitis B surface antigen test (Item is subject to rule 12)	13.90”.

3.25   Omit Schedule, Part 2, items 69274 and 69275, substitute:

“69274	Testing for Hepatitis C using:  Hepatitis C antibody test (Item is subject to rule 12)	13.90
69275	Investigation for acute or chronic Hepatitis D in a patient with a positive Hepatitis B surface antigen test using:  Hepatitis D antibody test (Item is subject to rule 12)	13.90”.

3.26   Schedule, Part 2, item 69277:

After “hepatitis,”, insert “or Hepatitis B or Hepatitis C carriage,”.

3.27   Schedule, Part 2, item 69278:

Omit “hepatitis”, substitute “hepatitis, or Hepatitis B or Hepatitis C carriage,”.

3.28   Schedule, Part 2, item 69279:

Omit “Hepatitis B or Hepatitis C”, substitute “Hepatitis B, Hepatitis C and Hepatitis D”.

3.29   Schedule, Part 2, item 69279:

After paragraph (e), insert:

“and (f) Hepatitis D antibody test (if Hepatitis B surface antigen test is positive) (if performed)”.

3.30   After Schedule, Part 2, item 69279, insert:

“69280 Determination of immune status to Hepatitis B and testing for Hepatitis C, including: (a) Hepatitis C antibody test; and (b) Hepatitis B core antibody test or Hepatitis B surface antibody test (Item is subject to rule 12) 24.70”.

3.31   After Schedule, Part 2, item 69282, insert:

“69283 Investigation for acute Hepatitis A and Hepatitis C in a patient with a currently elevated transaminase level, including: (a) Hepatitis A IgM antibody test; and (b) Hepatitis C antibody test (Item is subject to rule 12) 24.70”.

3.32   Omit Schedule, Part 2, items 72801, 72803, 72805 and 72807, substitute:

“72813	Examination of complexity level 2 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—1 or more separately identified specimens	79.00
72816	Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—1 separately identified specimen	84.50
72817	Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—2 or more separately identified specimens	90.00
72823	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—1 separately identified specimen	90.00
72824	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—2 to 4 separately identified specimens	96.00
72825	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—5 or more separately identified specimens	102.00
72830	Examination of complexity level 5 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—1 or more separately identified specimens	105.00
72836	Examination of complexity level 6 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions—1 or more separately identified specimens	115.00
72846	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen—1 to 3 antibodies	30.00
72847	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen—4 or more antibodies	40.00
72851	Electron microscopic examination of biopsy material—1 separately identified specimen	150.00
72852	Electron microscopic examination of biopsy material—2 or more separately identified specimens	200.00
72855	Intraoperative frozen section diagnosis of biopsy material—1 separately identified specimen	150.00
72856	Intraoperative frozen section diagnosis of biopsy material—2 or more separately identified specimens	200.00”.

3.33   Schedule, Part 2, item 73045:

Omit “35.80”, substitute “45.00”.

3.34   Schedule, Part 2, item 73047:

Omit “80.80”, substitute “90.00”.

3.35   Schedule, Part 2, item 73049:

Omit “51.75”, substitute “65.00”.

3.36   Schedule, Part 2, item 73051:

Omit “88.85”, substitute “163.85”.

3.37   Schedule, Part 2, item 73053:

After paragraph (b), insert:

“or (c) if there is inadequate information provided to use item 73055;”.

3.38   Schedule, Part 2, item 73903:

Omit “a service described in item 72801”, substitute “1 or more services described in items 72813, 72816, 72817, 72823, 72824, 72825, 72830 and 72836”.

3.39   Schedule, Part 2, item 73905:

Omit “a service described in item 72801”, substitute “1 or more services described in items 72813, 72816, 72817, 72823, 72824, 72825, 72830 and 72836”.

3.40   Omit Schedule, Part 2, item 73911, substitute:

“73910	Initiation of a patient episode by collection of a specimen for a service (other than a service described in item 73901, 73903 or 73905, or in Group P9) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in the place where the person was residing	10.00
73912	Initiation of a patient episode by collection of a specimen for a service (other than a service described in item 73901, 73903 or 73905, or in Group P9) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in a nursing home or institution	10.00”.

3.41   Add at the end of the Schedule:

“PART 4—COMPLEXITY LEVELS for histopathology items

Specimen Type	Complexity Level
Adrenal resection, neoplasm	5
Adrenal resection, not neoplasm	4
Aneurysm—all types	3
Anus, fissure or fistula	3
Anus, haemorrhoids	3
Anus tag	3
Appendix	3
Artery, atheromatous plaque	3
Artery, biopsy	4
Bartholin’s gland—cyst	3
Bile duct, resection—all specimens	6
Bone, biopsy, currettings or fragments—lesion	5
Bone, biopsy or currettings quantitation—metabolic disease	6

Bone, femoral head

4

Bone, resection, neoplasm—all sites and types

6

Bone marrow, biopsy

4

Bone—all specimens not otherwise specified

4

Brain neoplasm, resection—cerebello-pontine angle

4

Brain or meninges, biopsy—all lesions

5

Brain or meninges, not neoplasm—temporal lobe

6

Brain or meninges, resection—neoplasm (intracranial)

5

Brain or meninges, resection—not neoplasm

4

Branchial cleft, cyst

4

Breast, biopsy, excision—non-palpable malignant neoplasm

6

Breast, biopsy, excision—palpable malignant neoplasm

6

Breast, biopsy, needle with localization

6

Breast, mastectomy with nodes (including radical)

6

Breast tissue—not otherwise specified

4

Bronchus, biopsy

4

Carotid body—neoplasm

5

Cholesteatoma

3

Digits, amputation—not traumatic

4

Digits, amputation—traumatic

2

Endocrine neoplasm—not otherwise specified

5

Extremity, amputation or disarticulation—neoplasm

6

Extremity, amputation—not otherwise specified

4

Eye, conjunctiva—biopsy or pterygium

3

Eye, cornea

4

Eye, enucleation

 or exenteration—all lesions

5

Eye—not otherwise specified

4

Fallopian tube, biopsy

4

Fallopian tube, ectopic pregnancy

4

Fallopian tube, sterilization

2

Fetus with dissection

6

Foreskin—new born

2

Foreskin—not new born

3

Gallbladder

3

Gallbladder and porta hepatis—radical resection

6

Ganglion cysts

3

Glomus, neoplasm

4

Gum or oral mucosa, biopsy

4

Heart valve

4

Heart—not otherwise specified

5

Hernia sac

2

Hydrocele sac

2

Joint tissue including bone

4

Joint—all structures other than bone

3

Kidney, biopsy including transplant

5

Kidney, nephrectomy transplant

5

Kidney, partial or total nephrectomy or nephroureterectomy—neoplasm

5

Kidney, partial or total nephrectomy—not neoplasm

4

Large bowel, biopsy—all sites

4

Large bowel, colostomy—stoma

3

Large bowel, polyp

4

Large bowel, segmental resection—colon, not neoplasm

5

Large bowel (including rectum), neoplasm

6

Larynx, biopsy

4

Larynx, partial or total resection

5

Larynx, resection with nodes or pharynx or both

6

Lip, biopsy or wedge resection

4

Liver, hydatid cyst—resection for trauma

4

Liver—all specimens not otherwise specified

5

Lung, needle or transbronchial biopsy

4

Lung, resection—neoplasm

6

Lung, wedge biopsy

5

Lung segment, lobe or total—not neoplasm

5

Lymph node, biopsy—all sites

4

Lymph nodes, regional resection—all sites

5

Mediastinum mass

5

Muscle, biopsy

5

Nasopharynx or oropharynx, biopsy

4

Nerve, biopsy neuropathy

5

Nerve, neurectomy or removal of neoplasm

4

Nerve—not otherwise specified

3

Nose, mucosal biopsy

4

Nose or sinuses, polyps

3

Odontogenic neoplasm

5

Odontogenic or dental cyst

4

Oesophagus, biopsy

4

Oesophagus, diverticulum

3

Oesophagus, partial or total resection

6

Omentum, biopsy

4

Ovary with or without tube—neoplasm

5

Ovary with or without tube—not neoplasm

4

Pancreas, biopsy

5

Pancreas, cyst

4

Pancreas, subtotal or total with or without splenectomy

6

Parathyroid gland(s)

4

Penisectomy with node dissection

5

Penisectomy—simple

4

Periarticular tissue—ganglion cyst

3

Periarticular tissue—not otherwise specified

4

Peritoneum, biopsy

4

Pituitary neoplasm

4

Placenta—not third trimester

4

Placenta—third trimester, abnormal pregnancy or delivery

4

Pleura or pericardium, biopsy or tissue

4

Products of conception, spontaneous or missed abortion

4

Products of conception, termination of pregnancy

3

Prostate, radical resection

6

Prostate—all types of specimen not otherwise specified

4

Retroperitoneum, neoplasm

5

Salivary gland, Mucocele

3

Salivary gland, neoplasm—all sites

5

Salivary gland—all specimens not otherwise specified

4

Sinus, front nasal, ethmoidectomy

6

Sinus, paranasal, biopsy

4

Sinus, paranasal, resection—neoplasm

5

Skin, biopsy—blistering skin diseases

5

Skin, biopsy—inflammatory dermatosis

5

Skin, local resection—orientation or margins, at least 5cm long

4

Skin—all specimens not otherwise specified including all neoplasms

3

Small bowel, diverticulum

3

Small bowel, resection—neoplasm

6

Small bowel—all specimens not otherwise specified

4

Soft tissue, extensive resection at least 5cm long—neoplasm

6

Soft tissue, lipoma and variants

3

Soft tissue, neoplasm, not lipoma—all specimens

5

Soft tissue—not otherwise specified

4

Spleen

5

Stomach, biopsy

4

Stomach, resection, neoplasm—all specimens

6

Stomach—all specimens not otherwise specified

4

Tendon or tendon sheath, ganglion cyst

3

Tendon or tendon sheath, giant cell neoplasm

4

Tendon or tendon sheath—not otherwise specified

4

Testis, biopsy

5

Testis and adjacent structures, castration

2

Testis and adjacent structures, neoplasm with or without nodes

5

Testis and adjacent structures, vas deferens sterilization

2

Testis and adjacent structures—not otherwise specified

3

Thymus—not otherwise specified

5

Thyroglossal duct—all lesions

4

Thyroid—all specimens

5

Tissue or organ not otherwise specified, abscess

3

Tissue or organ not otherwise specified, haematoma

3

Tissue or organ not otherwise specified, malignant neoplasm with regional nodes

6

Tissue or organ not otherwise specified, neoplasm local

4

Tissue or organ not otherwise specified, pilonidal cyst or sinus

3

Tissue or organ not otherwise specified, thrombus or embolus

3

Tissue or organ not otherwise specified, veins varicosity

3

Tissue or organ—all specimens not otherwise specified

3

Tongue, biopsy

4

Tongue or tonsil, neoplasm local

5

Tongue or tonsil, neoplasm with nodes

6

Tonsil, biopsy—excluding resection of whole organ

4

Tonsil or adenoids or both

2

Trachea, biopsy

4

Ureter, biopsy

4

Ureter, resection

5

Urethra, biopsy

4

Urethra, resection

5

Urinary bladder, partial or total with or without prostatectomy

6

Urinary bladder, transurethral resection of neoplasm

5

Urinary bladder—all specimens not otherwise specified

4

Uterus, cervix, curettings or biopsy

4

Uterus, cervix cone, biopsy

5

Uterus, endocervix, polyp

4

Uterus, endometrium, polyp

4

Uterus with or without adnexa, malignant neoplasm—all specimen types not otherwise specified

5

Uterus with or without adnexa, neoplasm, Wertheim’s or pelvic clearance

6

Uterus—all specimens not otherwise specified

4

Vagina, biopsy

4

Vagina, radical resection

6

Vaginal mucosa, incidental

3

Vulva or labia, biopsy

4

Vulval, subtotal or

 total with or without nodes

6”.

NOTES

1. Notified in the Commonwealth of Australia Gazette on 20 March 1997.

2. Statutory Rules 1996 No. 232.